EP3495822B1 - Procédé d'évaluation de l'infarctus du myocarde aigu fondé sur une analyse hautement sensible de la troponine cardiaque - Google Patents

Procédé d'évaluation de l'infarctus du myocarde aigu fondé sur une analyse hautement sensible de la troponine cardiaque Download PDF

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EP3495822B1
EP3495822B1 EP18205921.2A EP18205921A EP3495822B1 EP 3495822 B1 EP3495822 B1 EP 3495822B1 EP 18205921 A EP18205921 A EP 18205921A EP 3495822 B1 EP3495822 B1 EP 3495822B1
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sample
troponin
instances
antibody
label
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EP3495822A1 (fr
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Philippe Goix
Robert Puskas
John Todd
Richard Livingston
Douglas Held
Alan H. Wu
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Novilux LLC
University of California
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University of California
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    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
    • G01N33/6887—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids from muscle, cartilage or connective tissue
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N15/00—Investigating characteristics of particles; Investigating permeability, pore-volume, or surface-area of porous materials
    • G01N15/06—Investigating concentration of particle suspensions
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N15/00—Investigating characteristics of particles; Investigating permeability, pore-volume, or surface-area of porous materials
    • G01N15/10—Investigating individual particles
    • G01N15/14—Electro-optical investigation, e.g. flow cytometers
    • G01N15/1456—Electro-optical investigation, e.g. flow cytometers without spatial resolution of the texture or inner structure of the particle, e.g. processing of pulse signals
    • G01N15/1459—Electro-optical investigation, e.g. flow cytometers without spatial resolution of the texture or inner structure of the particle, e.g. processing of pulse signals the analysis being performed on a sample stream
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N21/00—Investigating or analysing materials by the use of optical means, i.e. using sub-millimetre waves, infrared, visible or ultraviolet light
    • G01N21/62—Systems in which the material investigated is excited whereby it emits light or causes a change in wavelength of the incident light
    • G01N21/63—Systems in which the material investigated is excited whereby it emits light or causes a change in wavelength of the incident light optically excited
    • G01N21/64—Fluorescence; Phosphorescence
    • G01N21/6428—Measuring fluorescence of fluorescent products of reactions or of fluorochrome labelled reactive substances, e.g. measuring quenching effects, using measuring "optrodes"
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/577—Immunoassay; Biospecific binding assay; Materials therefor involving monoclonal antibodies binding reaction mechanisms characterised by the use of monoclonal antibodies; monoclonal antibodies per se are classified with their corresponding antigens
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/58—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving labelled substances
    • G01N33/582—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving labelled substances with fluorescent label
    • G01N15/075—
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N15/00—Investigating characteristics of particles; Investigating permeability, pore-volume, or surface-area of porous materials
    • G01N15/10—Investigating individual particles
    • G01N2015/1006—Investigating individual particles for cytology
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N15/00—Investigating characteristics of particles; Investigating permeability, pore-volume, or surface-area of porous materials
    • G01N15/10—Investigating individual particles
    • G01N15/14—Electro-optical investigation, e.g. flow cytometers
    • G01N2015/1486—Counting the particles
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2201/00—Features of devices classified in G01N21/00
    • G01N2201/12—Circuits of general importance; Signal processing
    • G01N2201/124—Sensitivity
    • G01N2201/1247—Thresholding
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2201/00—Features of devices classified in G01N21/00
    • G01N2201/12—Circuits of general importance; Signal processing
    • G01N2201/127—Calibration; base line adjustment; drift compensation
    • G01N2201/12746—Calibration values determination
    • G01N2201/12761—Precalibration, e.g. for a given series of reagents
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/32—Cardiovascular disorders
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/32—Cardiovascular disorders
    • G01N2800/324—Coronary artery diseases, e.g. angina pectoris, myocardial infarction
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T436/00—Chemistry: analytical and immunological testing
    • Y10T436/10—Composition for standardization, calibration, simulation, stabilization, preparation or preservation; processes of use in preparation for chemical testing
    • Y10T436/105831—Protein or peptide standard or control [e.g., hemoglobin, etc.]

Definitions

  • CK-MB creatine kinase-MB
  • Lam Q. et al., CLIN CHEM, 52(2), 2006, 298-300 and Uettwiller-Geiger D. et al., CLIN CHEM, 48(6), 2002, 869-876 disclose automated troponin I assays. However, their functional sensitivity does not allow to use threshold concentrations in the single-digit pg/mL range for the diagnosis or prognosis of myocardial infarct.
  • the invention relates to a method for diagnosing, predicting or prognosing acute myocardial infarction (AMI) in an individual comprising: assaying a sample from the individual for cardiac troponin I (cTnI) and detecting a concentration of cTnI in the sample, wherein the sample is a plasma sample or a serum sample from blood; wherein said concentration is determined by a cTnI assay with a limit of detection for said cTnI in said sample of less than 5 pg/ml; and comparing the detected concentration of cTnI to a threshold concentration of 7 pg/ml; wherein a cTnI level over the threshold concentration in a single sample indicates, predicts, or provides a basis for prognosis of AMI; wherein the individual is human.
  • AMI acute myocardial infarction
  • the sample is a serum sample.
  • the cTnI level is determined at or near the time the individual presents to a health professional with one or more symptoms indicative of AMI.
  • the one or more symptoms are chest pain, chest pressure, arm pain, abnormal EKG, abnormal enzyme levels, or shortness of breath.
  • Disclosed herein, but not an aspect of the invention is a method for determining the presence or absence of a single molecule of troponin or a fragment or complex thereof in a sample, including i) labeling the molecule, fragment, or complex, if present, with a label; and ii) detecting the presence or absence of the label, where the detection of the presence of the label indicates the presence of the single molecule, fragment, or complex of troponin in the sample.
  • the troponin may be a cardiac isoform of troponin.
  • the troponin can be cardiac troponin I (cTnI) or cardiac troponin C (cTnC).
  • the troponin may be cTnI.
  • a single molecule of troponin can be detected at a limit of detection of less than about 100 pg/ml.
  • a single molecule or troponin can be detected at a level of detection of less than about 20 pg/ml.
  • the label may includes a fluorescent moiety.
  • the fluorescent moiety may be capable of emitting at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot not less than about 5 microns in diameter that contains the moiety, and where the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the fluorescent moiety may include a molecule that contains at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance group.
  • the fluorescent moiety may include a dye. Examples of dyes include, but are not limited to, AlexaFluor 488, AlexaFluor 532, AlexaFluor 647, AlexaFluor 680 and AlexaFluor 700.
  • the fluorescent moiety may include AlexaFluor 647.
  • the fluorescent moiety a molecule that contains at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring may contain a chemically reactive group or a conjugated substance group.
  • the label may further include a binding partner for the troponin molecule, fragment, or complex.
  • the binding partner may include an antibody specific to the troponin molecule, fragment, or complex.
  • the antibody may be specific to a specific region of the troponin molecule.
  • the antibody may be specific to a region comprising amino acids 27-41 of cardiac troponin I.
  • the antibody can be a polyclonal antibody.
  • the antibody may be a monoclonal antibody.
  • the methods may further include capturing troponin or troponin complex on a solid support.
  • the solid support can be a microtiter plate or paramagnetic beads.
  • the solid support may include capture partner specific for the troponin or troponin complex that is attached to the solid support. The attachment of the capture partner to the solid support may be noncovalent.
  • the attachment of the capture partner to the solid support may be covalent.
  • the covalent attachment of the capture partner may be such that the capture partner is attached to the solid support in a specific orientation.
  • the specific orientation may serve to maximize specific binding of the troponin or troponin complex to the capture partner.
  • the capture partner may comprise an antibody.
  • the antibody may be a monoclonal antibody.
  • the antibody may be specific to amino acids 87-91 of cardiac troponin I.
  • the antibody may be specific to amino acids 41-49 of cardiac troponin I.
  • the sample may be a blood, serum, or plasma sample.
  • the sample may be a serum sample.
  • the label may include a fluorescent moiety, and step ii) may include passing the label through a single molecule detector.
  • the single molecule detector may include: a) an electromagnetic radiation source for stimulating the fluorescent moiety; b) a capillary flow cell for passing the fluorescent moiety; c) a source of motive force for moving the fluorescent moiety in the capillary flow cell; d) an interrogation space defined within the capillary flow cell for receiving electromagnetic radiation emitted from the electromagnetic source; e) an electromagnetic radiation detector operably connected to the interrogation space for measuring an electromagnetic characteristic of the stimulated fluorescent moiety; and f) a microscope objective lens situated between the interrogation space and the detector, where the lens is a high numerical aperture lens.
  • the invention provides a method for diagnosing, preducting or prognosing acute myocardial infraction (AMI) in an individual comprising: assaying a sample from the individual for cardiac troponin I (cTnI) and detecting a concentration of cTnI in the sample, wherein the sample is a plasma sample or a serum sample from blood; wherein said concentration is determined by a cTnI assay with a limit of detection for said ctni in said sample of less than 5 pg/ml; and comparing the detected concentration of cTnI to a threshold concentration of 7 pg/ml; wherein a cTnI level over the threshold concentration in a single sample indicates, predicts, or provides a basis for prognosis of AMI; wherein the individual is human.
  • AMI acute myocardial infraction
  • the threshold concentration is determined by determining a the 99th percentile concentration of troponin in a group of normal individuals, and setting the threshold concentration at the 99th percentile concentration.
  • at least one sample is taken during or after a cardiac stress test.
  • the cardiac troponin is cardiac troponin I.
  • the concentration of cardiac troponin is a concentration of total cardiac troponin.
  • the concentration of cardiac troponin is a concentration of a cardiac troponin complex, cardiac troponin fragment, phosphorylated cardiac troponin, oxidized cardiac troponin, or a combination thereof.
  • the concentration of cardiac troponin may be compared to total cardiac troponin.
  • the diagnosis, prognosis is a diagnosis, prognosis, acute myocardial infraction.
  • the diagnosis, prognosis comprises risk stratification for level of risk of acute myocardial infarction.
  • the concentration or series of concentrations is determined at or near the time the individual presents to a health professional with one or more symptoms indicative of myocardial ischemia or infarct or the possibility thereof.
  • the one or more symptoms can be chest pain, chest pressure, arm pain, abnormal EKG, abnormal enzyme levels, or shortness of breath.
  • the concentration is determined by a method that includes detecting single molecules of troponin, or complexes or fragments thereof.
  • the methods of the invention involve labeling troponin or a troponin complex with a label that comprises a fluorescent moiety.
  • the fluorescent moiety is capable of emitting at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot 5 microns in diameter that contains the moiety, and where the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the fluorescent moiety includes a molecule that contains at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance group.
  • the fluorescent moiety includes a dye selected from the group consisting of AlexaFluor 488, AlexaFluor 532, AlexaFluor 647, AlexaFluor 680 or AlexaFluor 700.
  • the fluorescent moiety comprises AlexaFluor 647.
  • the label further comprises a binding partner for the troponin.
  • the binding partner comprises an antibody specific to the troponin.
  • the antibody is a polyclonal antibody.
  • the methods further include capturing troponin or troponin complex on a solid support.
  • the solid support can be a microtiter plate or paramagnetic beads.
  • the attachment of the capture partner to the solid support is noncovalent. In some embodiments of the methods of the invention, the attachment of the capture partner to the solid support is covalent.
  • the covalent attachment of the capture partner is such that the capture partner is attached to the solid support in a specific orientation.
  • the specific orientation serves to maximize specific binding of the troponin or troponin complex to the capture partner.
  • step i) further involves assessing another indicator for the individual.
  • step ii) involves determining a diagnosis, prognosis in the individual, based on the concentration of troponin and the assessment of the other indicator of the non-troponin marker in the sample, or on the concentrations in the series of samples.
  • the other indicator is a clinical indicator of myocardial ischemia or infarct.
  • the other indicator is the concentration of one or more non-troponin markers in the sample or the series of samples.
  • the one or more markers are markers of cardiac ischemia, or markers of inflammation and of plaque instability.
  • the one or more markers of cardiac ischemia can be creatine kinase (CK) and its myocardial fraction CK myocardial band (MB), aspartate aminotransferase, lactate dehydrogenase (LDH), ⁇ -hydroxybutyrate dehaydrogenase, myoglobin, glutamate oxaloacetate transaminase, glycogen phosphorylase BB, unbound free fatty acids, heart fatty acid binding protein (H-FABP), ischemia-modified albumin, myosin light chain 1, or myosin light chain 2.
  • CK creatine kinase
  • MB myocardial fraction CK myocardial band
  • LDH lactate dehydrogenase
  • the one or more markers include one or more specific markers of myocardial injury. Further disclosed, but not an aspect of the invention is a diagnosis, prognosis, or method of treatment of a condition that is not myocardial infarct.
  • the condition is may be cardiac toxicity.
  • the cardiac toxicity may be associated with the administration of a drug to the individual.
  • the condition may be selected from the group consisting of acute rheumatic fever, amyloidosis, cardiac trauma (including contusion, ablation, pacing, firing, cardioversion, catheterization and cardiac surgery), reperfusion injury, congestive heart failure, end-stage renal failure, glycogen storage disease type II (Pompe's disease), heart transplantation, haeomoglobinopathy with transfusion haemosiderosis, hypertension, including gestational hypertension, hypotension, often with arrhythmias, hypothyroidism, myocarditis, pericarditis, post-operative noncardiac surgery, pulmonary embolism, and sepsis.
  • cardiac trauma including contusion, ablation, pacing, firing, cardioversion, catheterization and cardiac surgery
  • reperfusion injury congestive heart failure
  • end-stage renal failure glycogen storage disease type II (Pompe's disease)
  • heart transplantation haeomoglobinopathy with transfusion haemosiderosis
  • hypertension including gestational hyper
  • compositions are disclosed herein, but not an aspect of the invention.
  • a composition for the detection of a troponin isoform including a binding partner to the troponin isoform attached to a fluorescent moiety, where the fluorescent moiety is capable of emitting at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot not less than about 5 microns in diameter that contains the moiety, and where the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the binding partner may comprise an antibody to the troponin isoform.
  • the antibody may be a polyclonal antibody.
  • the antibody may be a monoclonal antibody.
  • the troponin isoform may be a cardiac isoform.
  • the cardiac isoform may be selected from the group consisting of cTnI and cTnT.
  • the cardiac isoform may be cTnI.
  • the antibody may be specific to a specific region of the troponin molecule.
  • the antibody may be specific to a region comprising amino acids 27-41 of cardiac troponin I.
  • the compositions of the invention, the fluorescent moiety may comprise a molecule that comprises at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance group.
  • the fluorescent moiety may include a dye that can be AlexaFluor 488, AlexaFluor 532, AlexaFluor 647, AlexaFluor 680 or AlexaFluor 700.
  • the fluorescent moiety may comprise AlexaFluor 647.
  • a composition may comprise a set of standards for the determination of a concentration of a cardiac troponin, where at least one of the standards is at a concentration of cardiac troponin less than about 10 pg/ml.
  • kits containing a composition including an antibody to cardiac troponin attached to a fluorescent dye moiety, where the moiety is capable of emitting at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot not less than about 5 microns in diameter that contains the moiety, and where the total energy directed at the spot by the laser is no more than about 3 microJoules, where the composition is packaged in suitable packaging.
  • the cardiac troponin may be cardiac troponin I or cardiac troponin T.
  • the cardiac troponin may be cardiac troponin I.
  • the kits may further include instructions.
  • kits may further include a composition containing a capture antibody for the cardiac troponin I attached to a solid support.
  • the solid support may comprise a microtiter plate or paramagnetic microparticles.
  • the kits may further include a component selected romthe group consisting of wash buffer, assay buffer, elution buffer, and calibrator diluent.
  • the kits may further include a standard for the cardiac troponin.
  • compositions and methods for the highly sensitive detection of troponin e.g., cardiac troponin.
  • the release into the blood of the cardiac isoforms of troponin, which are unique to cardiac muscle (cardiac troponin I and/or T) is indicative of damage to cardiac muscle, and provides the basis for their use as diagnostic or prognostic markers, or to aid in determination of treatment.
  • troponin complex in muscle consists of troponin I, C and T.
  • Troponin C exists as two isoforms, one from cardiac and slow-twitch muscle and one from fast-twitch muscle; because it is found in virtually all striated muscle, its use as a specific marker is limited.
  • troponin I and T are expressed as different isoforms in slow-twitch, fast-twitch and cardiac muscle.
  • the unique cardiac isoforms of troponin I and T allow them to be distinguished immunologically from the other troponins of skeletal muscle. Therefore, the release into the blood of cardiac troponin I and T is indicative of damage to cardiac muscle, and provides the basis for their use as diagnostic or prognostic markers, or to aid in determination of treatment.
  • CK-MB creatine kinase-MB
  • the troponins are very sensitive and specific markers of cardiac injury. In addition to cardiac infarct, a number of other conditions can cause damage to the heart muscle, and early detection of such damage would prove useful to clinicians. However, present methods of detection and quantitation of cardiac troponin do not possess sufficient sensitivity to detect the release of cardiac troponin into the blood until levels have reached abnormally high concentrations, e.g., 0.1 ng/ml or greater.
  • the methods and compositions disclosed herein thus include methods and compositions for the highly sensitive detection and quantitation of cardiac troponin, and compositions and methods for diagnosis, prognosis, and/or determination of treatment based on such highly sensitive detection and quantitation.
  • cardiac troponin I cardiac troponin I
  • cTnT cardiac troponin C
  • the two forms are subject to virtually immediate proteolytic degradation, resulting in a variety of fragments.
  • various phosphorylated and oxidized forms of the troponins may exist in the blood. See, e.g., U.S. Patent No. 6,991,907 .
  • cardiac troponin encompasses all forms of cardiac troponin, including
  • the invention provides methods and compositions for the detection and/or determination of concentration of total cardiac troponin I, i.e., the sum of all or a substantial portion of the cardiac troponin I in a sample, e.g., blood, serum or plasma sample, whether it is free, complexed, a proteotlytic fragment, phosphorylated, oxidized, or otherwise modified.
  • the cardiac troponin is cTnI. It will be appreciated that an absolute total measurement need not be achieved, as long as a consistent proportion of the total is determined, which can be compared to standard values.
  • total cardiac troponin refers to a measurement that is intended to measure all or substantially all forms of a particular cardiac troponin, e.g., all cTnI, or all cTnT, in a sample, where the sample-to-sample consistency is such that clinically relevant conclusions may be drawn from comparisons of samples to standards, or comparison of one sample to another.
  • the invention provides methods and compositions for the detection and/or determination of concentration of one or more of the various forms of troponin I in the sample as a separate entity, e.g., complexed cTnI, free cTnI, muddied cTnI (e.g., oxidized or phosphorylated), and, typically, can provide a concentration for that form in the sample. In the latter embodiments, ratios or absolute values may be determined for the different entities.
  • the invention provides methods of detecting and, typically, determining the concentration of one or more forms of complexed troponin I, or one or more fragments of troponin I, or one or more oxidized or phosphorylated forms of troponin I.
  • concentrations of the various forms may be determined e.g., by performing multiplexed assays on a single sample for the different entities, or by performing separate assays on aliquots from the same or similar samples. Ratios of concentrations of the various forms may be obtained. For example, a ratio of the concentration of a particular form, e.g., a fragment, complex, or modified form, of the cardiac troponin to the concentration of total cardiac troponin, may be determined. These ratios and/or absolute values can provide meaningful clinical information.
  • the relative proportion of fragments of cardiac troponin can indicate the length of time since release into the blood and thus, indirectly, length of time since, e.g., myocardial infarct. See, e.g., U.S. Patent No U.S. Patent No. 6,991,907 .
  • the invention provides methods that include labels for the highly sensitive detection and quantitation of cardiac troponin.
  • the labels may be attached by any known means, including methods that utilize non-specific or specific interactions of label and target. Labels may provide a detectable signal or affect the mobility of the particle in an electric field. In addition, labeling can be accomplished directly or through binding partners.
  • the label comprises a binding partner to troponin attached to a fluorescent moiety.
  • binding partner with the requisite specificity for the form of cardiac troponin to be detected may be used.
  • a binding partner specific to all or substantially all forms of cTnI may be used; typically such binding partners bind to a region of the cardiac troponin that is common to all or most of the different forms likely to be found in a sample.
  • a binding partner specific to one or more particular forms of cardiac troponin may be used, e.g., a binding partner to complexed cTnI, free cTnI, muddied cTnI (e.g., oxidized or phosphorylated).
  • Binding partners are known in the art and include, e.g., aptamers, lectins, and receptors.
  • a useful and versatile type of binding partner is an antibody.
  • the binding partner is an antibody specific for a cardiac troponin.
  • antibody is a broad term and is used in its ordinary sense, including, without limitation, to refer to naturally occurring antibodies as well as non-naturally occurring antibodies, including, for example, single chain antibodies, chimeric, bifunctional and humanized antibodies, as well as antigen-binding fragments thereof.
  • the antibody is specific for cTnI.
  • the label includes antibodies to cTnI. The antibody may be specific to all or substantially all forms of cTnI.
  • an antibody specific to one or more particular forms of cardiac troponin may be used, e.g., a binding partner to complexed cTnI, free cTnI, muddied cTnI (e.g., oxidized or phosphorylated).
  • a binding partner to complexed cTnI, free cTnI, muddied cTnI e.g., oxidized or phosphorylated.
  • Mixtures of antibodies are also encompassed by the invention, e.g., mixtures of antibodies to cTnI, or mixtures of antibodies to the various forms of the troponin (free, complexed, etc.), or mixtures of mixtures.
  • the choice of epitope or region of troponin to which the antibody is raised will determine its specificity, e.g., for total troponin, for certain fragments, for complexed troponin, for modified troponin, and the like.
  • the antibody is specific to a specific amino acid region of a cardiac troponin. In some embodiments, the antibody is specific to amino acids 27-41 of human cardiac troponin I. Both monoclonal and polyclonal antibodies are useful as binding partners.
  • the antibody is a polyclonal antibody. In some embodiments, the antibody is a monoclonal antibody. In some embodiments, the antibody is a polyclonal antibody specific to amino acids 27-41 of human cardiac troponin I. In some embodiments, this antibody is not affected by heparin, phosphorylation, oxidation and troponin complex formation, and does not cross-react with skeletal muscle troponin I.
  • Monoclonal and polyclonal antibodies to free and complexed cardiac troponins are also commercially available (HyTest, HyTest Ltd.,Turku Finland; Abcam Inc., Cambridge, MA, USA, Life Diagnostics, Inc., West Chester, PA, USA; Fitzgerald Industries International, Inc., Concord, MA 01742-3049 USA; BiosPacific, Emeryville, CA).
  • the antibody is a mammalian, e.g., goat polyclonal anti-cTnI antibody.
  • the antibody may be specific to specific regions of the cTnI, e.g., amino acids 27-41 of human cardiac troponin I.
  • Capture binding partners and detection binding partner pairs e.g., capture and detection antibody pairs, may be used in embodiments of the invention.
  • a heterogeneous assay protocol is used in which, typically, two binding partners, e.g., two antibodies, are used.
  • One binding partner is a capture partner, usually immobilized on a solid support, and the other binding partner is a detection binding partner, typically with a detectable label attached.
  • the capture binding partner member of a pair is an antibody that is specific to all or substantially all forms of cardiac troponin.
  • An example is an antibody, e.g., a monoclonal antibody, specific to free cardiac troponin I (cTnI) a.a. 41-49 and cTnI forming complexes with other troponin components.
  • this antibody is not affected by heparin, phosphorylation, oxidation and troponin complex formation, and does not cross-react with skeletal muscle troponin I.
  • a monoclonal antibody specific to cardiac troponin I (cTnI) a.a. 87-91 and does not cross-react with skeletal muscle troponin I.
  • Such antibodies are available from Bios Pacific, Emeryville, CA. Other antibody pairs are known or can be designed.
  • Cross-reacting antibodies In some embodiments it is useful to use an antibody that cross-reacts with a variety of species, either as a capture antibody, a detection antibody, or both. Such embodiments include the measurement of drug toxicity by determining, e.g., release of cardiac troponin into the blood as a marker of cardiac damage.
  • a cross-reacting antibody allows studies of toxicity to be done in one species, e.g. a non-human species, and direct transfer of the results to studies or clinical observations of another species, e.g., humans, using the same antibody or antibody pair in the reagents of the assays, thus decreasing variability between assays.
  • one or more of the antibodies for use as a binding partner to the marker, e.g., cardiac troponin, such as cardiac troponin I may be a cross-reacting antibody.
  • the antibody cross-reacts with the marker, e.g. cardiac troponin, from at least two species selected from the group consisting of human, monkey, dog, and mouse.
  • the antibody cross-reacts with the marker e.g. cardiac troponin, from all of the group consisting of human, monkey, dog, and mouse.
  • the binding partner e.g., antibody
  • a fluorescent moiety is attached to a fluorescent moiety.
  • the fluorescence of the moiety will be sufficient to allow detection in a single molecule detector, such as the single molecule detectors described herein.
  • a "fluorescent moiety,” as that term is used herein, includes one or more fluorescent entities whose total fluorescence is such that the moiety may be detected in the single molecule detectors described herein.
  • a fluorescent moiety may comprise a single entity (e.g., a Quantum Dot or fluorescent molecule) or a plurality of entities (e.g., a plurality of fluorescent molecules).
  • moiety refers to a group of fluorescent entities, e.g., a plurality of fluorescent dye molecules, each individual entity may be attached to the binding partner separately or the entities may be attached together, as long as the entities as a group provide sufficient fluorescence to be detected.
  • the fluorescence of the moiety involves a combination of quantum efficiency and lack of photobleaching sufficient that the moiety is detectable above background levels in a single molecule detector, with the consistency necessary for the desired level of detection, accuracy, and precision of the assay.
  • the fluorescence of the fluorescent moiety is such that it allows detection and/or quantitation of troponin at a level of detection of less than about 10, 5, 4, 3, 2, or 1 pg/ml and with a coefficient of variation of less than about 20, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1% or less, e.g., about 10% or less, in the instruments described herein.
  • the fluorescence of the fluorescent moiety is such that it allows detection and/or quantitation of troponin at a limit of detection of less than about 5 pg/ml and with a coefficient of variation of , less than about 10%, in the instruments described herein.
  • Limit of detection includes the lowest concentration at which one can identify a sample as containing a molecule of the substance of interest, e.g., the first non-zero value. It can be defined by the variability of zeros and the slope of the standard curve.
  • the limit of detection of an assay may be determined by running a standard curve, determining the standard curve zero value, and adding 2 standard deviations to that value. A concentration of the substance of interest that produces a signal equal to this value is the "lower limit of detection" concentration.
  • the moiety has properties that are consistent with its use in the assay of choice.
  • the assay is an immunoassay, where the fluorescent moiety is attached to an antibody; the moiety must have properties such that it does not aggregate with other antibodies or proteins, or experiences no more aggregation than is consistent with the required accuracy and precision of the assay.
  • fluorescent moieties that are preferred are fluorescent moieties, e.g., dye molecules that have a combination of 1) high absorption coefficient; 2) high quantum yield; 3) high photostability (low photobleaching); and 4) compatibility with labeling the biomolecule of interest (e.g., protein) so that it may be analyzed using the analyzers and systems disclosed herein (e.g., does not cause precipitation of the protein of interest, or precipitation of a protein to which the moiety has been attached).
  • fluorescent moieties e.g., dye molecules that have a combination of 1) high absorption coefficient; 2) high quantum yield; 3) high photostability (low photobleaching); and 4) compatibility with labeling the biomolecule of interest (e.g., protein) so that it may be analyzed using the analyzers and systems disclosed herein (e.g., does not cause precipitation of the protein of interest, or precipitation of a protein to which the moiety has been attached).
  • Fluorescent moieties e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that are useful in some embodiments of the invention may be defined in terms of their photon emission characteristics when stimulated by EM radiation.
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 10, 20, 30, 40, 50, 75, 100, 125, 150, 175, 200, 225, 250, 275, 300, 350, 400, 500, 600, 700, 800, 900, or 1000, photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 micro Joules.
  • the total energy may be achieved by many different combinations of power output of the laser and length of time of exposure of the dye moiety.
  • a laser of a power output of 1 mW may be used for 3 ms, 3 mW for 1 ms, 6 mW for 0.5 ms, 12 mW for 0.25 ms, and so on.
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 50 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 100 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 150 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules
  • the invention utilizes a fluorescent dye moiety, e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 300 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules
  • the invention utilizes a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 500 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • a fluorescent dye moiety e.g., a single fluorescent dye molecule or a plurality of fluorescent dye molecules, that is capable of emitting an average of at least about 500 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the fluorescent moiety comprises an average of at least about 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 fluorescent entities, e.g., fluorescent molecules. In some embodiments, the fluorescent moiety comprises an average of no more than about 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 fluorescent entities, e.g., fluorescent molecules. In some embodiments, the fluorescent moiety comprises an average of about 1 to 11, or about 2 to 10, or about 2 to 8, or about 2 to 6, or about 2 to 5, or about 2 to 4, or about 3 to 10, or about 3 to 8, or about 3 to 6, or about 3 to 5, or about 4 to 10, or about 4 to 8, or about 4 to 6, or about 2, 3, 4, 5, 6 , or more than about 6 fluorescent entities.
  • the fluorescent moiety comprises an average of about 2 to 8 fluorescent moieties are attached. In some embodiments, an average of about 2 to 6 fluorescent entities. In some embodiments, the fluorescent moiety comprises an average of about 2 to 4 fluorescent entities. In some embodiments, the fluorescent moiety comprises an average of about 3 to 10 fluorescent entities. In some embodiments, the fluorescent moiety comprises an average of about 3 to 8 fluorescent enties. In some embodiments, the fluorescent moiety comprises an average of about 3 to 6 fluorescent entities.
  • the molar ratio of the particular fluorscent entity of which the fluorescent moiety is comprise, to the binding partner corresponds to the number or range of numbers specified'
  • the label comprises a binding partner that is an antibody and a fluorescent moiety that comprises a plurality of fluorescent dye molecules of a specifc absorbance
  • a spectrophometric assay may be used in which a solution of the label is diluted to an appropriate level and the absorbance at 280 nm is taken to determine the molarity of the protein (antibody) and an absorbance at, e.g., 650 nm (for AlexaFluor 647) is taken to determine the molarity of the fluorescent dye molecule.
  • the ratio of the latter molarity to the former represents the average number of fluorescent entities (dye molecules
  • the invention utilizes fluorescent moieties that comprise fluorescent dye molecules.
  • the invention utilizes a fluorescent dye molecule that is capable of emitting an average of at least about 50 photons when simulated by a laser emitting light at the excitation wavelength of the molecule, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the molecule, and wherein the total energy directed at the spot by the laser is no more than about 3 micro Joules.
  • the invention utilizes a fluorescent dye molecule that is capable of emitting an average of at least about 75 photons when simulated by a laser emitting light at the excitation wavelength of the molecule, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the molecule, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the invention utilizes a fluorescent dye molecule that is capable of emitting an average of at least about 100 photons when simulated by a laser emitting light at the excitation wavelength of the molecule, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the molecule, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the invention utilizes a fluorescent dye molecule that is capable of emitting an average of at least about 150 photons when simulated by a laser emitting light at the excitation wavelength of the molecule, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the molecule, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the invention utilizes a fluorescent dye molecule that is capable of emitting an average of at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the molecule, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the molecule, and wherein the total energy directed at the spot by the laser is no more than about 3 micro Joules
  • the fluorescent entity is selected from the group consisting of Alexa Flour 488, 532, 647, 700, 750, Fluorescein, B-phycoerythrin, allophycocyanin, PBXL-3, and Qdot 605.
  • Quantum Dots Quantum Dots :Qdot 525, 565, 585, 605, 655, 705, 800
  • Suitable dyes for use in the invention include modified carbocyanine dyes.
  • the modification of carbocyanine dyes includes the modification of an indolium ring of the carbocyanine dye to permit a reactive group or conjugated substance at the number 3 position.
  • the modification of the indolium ring provides dye conjugates that are uniformly and substantially more fluorescent on proteins, nucleic acids and other biopolymers, than conjugates labeled with structurally similar carbocyanine dyes bound through the nitrogen atom at the number one position.
  • the modified carbocyanine dyes In addition to having more intense fluorescence emission than structurally similar dyes at virtually identical wavelengths, and decreased artifacts in their absorption spectra upon conjugation to biopolymers, the modified carbocyanine dyes have greater photostability and higher absorbance (extinction coefficients) at the wavelengths of peak absorbance than the structurally similar dyes. Thus, the modified carbocyanine dyes result in greater sensitivity in assays that use the modified dyes and their conjugates.
  • Preferred modified dyes include compounds that have at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance.
  • the labels utilize a fluorescent dye that includes a substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance group.
  • the label comprises a fluorescent moiety that includes one or more Alexa dyes (Molecular Probes, Eugene, OR).
  • Alexa dyes are disclosed in U.S. Patent 6,977,305 ; 6,974,874 ; 6,130,101 ; and 6,974,305 .
  • Some embodiments of the invention utilize a dye chosen from the group consisting of AlexaFluor 647, AlexaFluor 488, AlexaFluor 532, AlexaFluor 555, AlexaFluor 610, AlexaFluor 680, AlexaFluor 700, and AlexaFluor 750.
  • Some embodiments of the invention utilize a dye chosen from the group consisting of AlexaFluor 488, AlexaFluor 532, AlexaFluor 647, AlexaFluor 700 and AlexaFluor 750. Some embodiments of the invention utilize the AlexaFluor 647 molecule, which has an absorption maximum between about 650 and 660 nm and an emission maximum between about 660 and 670 nm. The AlexaFluor 647 dye is used alone or in combination with other AlexaFluor dyes.
  • organic fluors can be improved by rendering them less hydrophobic by adding hydrophilic groups such as polyethylene.
  • sulfonated organic fluors such as the AlexaFluor 647 dye can be rendered less acidic by making them zwitterionic.
  • Particles such as antibodies that are labeled with the modified fluors are less likely to bind non-specifically to surfaces and proteins in immunoassays, and thus enable assays that have greater sensitivity and lower backgrounds.
  • Methods for modifying and improving the properties of fluorescent dyes for the purpose of increasing the sensitivity of a system that detects single particles are known in the art.
  • the modification improves the Stokes shift while maintaining a high quantum yield.
  • the fluorescent label moiety that is used to detect a molecule in a sample using the analyzer systems of disclosed herein.
  • Quantum dots also known as semiconductor nanocrystals or artificial atoms, are semiconductor crystals that contain anywhere between 100 to 1,000 electrons and range from 2-10 nm. Some QDs can be between 10-20 nm in diameter. QDs have high quantum yields, which makes them particularly useful for optical applications: QDs are fluorophores that fluoresce by forming excitons, which can be thought of the excited state of traditional fluorophores, but have much longer lifetimes of up to 200 nanoseconds. This property provides QDs with low photobleaching.
  • the energy level of QDs can be controlled by changing the size and shape of the QD, and the depth of the QDs' potential.
  • One of the optical features of small excitonic QDs is coloration, which is determined by the size of the dot. The larger the dot, the redder, or more towards the red end of the spectrum the fluorescence. The smaller the dot, the bluer or more towards the blue end it is.
  • the bandgap energy that determines the energy and hence the color of the fluoresced light is inversely proportional to the square of the size of the QD. Larger QDs have more energy levels which are more closely spaced, thus allowing the QD to absorb photons containing less energy, i.e. those closer to the red end of the spectrum.
  • the protein that is detected with the single particle analyzer system is labeled with a QD.
  • the single particle analyzer is used to detect a protein labeled with one QD and using a filter to allow for the detection of different proteins at different wavelengths.
  • QDs have broad excitation and narrow emission properties which when used with color filtering require only a single electromagnetic source for multiplex analysis of multiple targets in a single sample to resolve individual signals.
  • the analyzer system comprises one continuous wave laser and particles that are each labeled with one QD.
  • Quantum dots are free floating and can be attached to a variety of molecules via metal coordinating functional groups. These groups include but are not limited to thiol, amine, nitrile, phosphine, phosphine oxide, phosphonic acid, carboxylic acids or other ligands.
  • the quantum dots can be dispersed or dissolved in nearly any solvent or incorporated into a variety of inorganic and organic films.
  • Quantum dots (QDs) can be coupled to streptavidin directly through a maleimide ester coupling reaction or to antibodies through a meleimide-thiol coupling reaction. This yields a material with a biomolecule covalently attached on the surface, which produces conjugates with high specific activity.
  • the protein that is detected with the single particle analyzer is labeled with one quantum dot.
  • the quantum dot is between 10 and 20 nm in diameter. In other instances, the quantum dot is between 2 and 10 nm in diameter.
  • Useful Quantum Dots include QD 605, QD 610, QD 655, and QD 705.
  • a particularly preferred Quantum Dot is QD 605.
  • the labels disclosed herein generally contain a binding partner, e.g., antibody, bound to a fluorescent moiety to provide the requisite fluorescence for detection and quantitation in the instruments described herein.
  • a binding partner e.g., antibody
  • Any suitable combination of binding partner and fluorescent moiety for detection in the single molecule detectors described herein may be used as a label in the invention.
  • a label for a cardiac troponin molecule, or fragment, complex, phosphorylated, or oxidized form thereof where the label includes an antibody to a cardiac troponin and a fluorescent moiety.
  • the antibody may be any antibody as described above, e.g., an antibody to cTnI. In some embodiments, the antibody is an antibody to cTnI.
  • the antibody is specific to a specific region of the cardiac troponin, e.g., specific to amino acids 27-41 of human cTnI.
  • a fluorescent moiety may be attached such that the label is capable of emitting an average of at least about 50, 75, 100, 125, 150, 175, 200, 225, 250, 275, 300, 350, 400, 500, 600, 700, 800,900, or 1000, photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the label, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the fluorescent moiety may be a fluorescent moiety that is capable of emitting an average of at least about 50, 100, 150, or 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the fluorescent moiety may be a fluorescent moiety that includes one or more dye molecules with a structure that includes a substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance group.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules selected from the group consisting of AlexaFluor 488, 532, 647, 700, or 750.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules selected from the group consisting of AlexaFluor 488, 532, 700, or 750.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 488.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 555.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 610.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 647.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 680.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 700.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 750.
  • composition for the detection of cardiac troponin I that includes an AlexFluor molecule, e.g. an AlexaFluor molecule selected from the described groups, such as an AlexaFluor 647 molecule attached to a to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • an AlexFluor molecule e.g. an AlexaFluor molecule selected from the described groups, such as an AlexaFluor 647 molecule attached to a to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • composition for the detection of cardiac troponin I that includes an average of 1 to 11, or about 2 to 10, or about 2 to 8, or about 2 to 6, or about 2 to 5, or about 2 to 4, or about 3 to 10, or about 3 to 8, or about 3 to 6, or about 3 to 5, or about 4 to 10, or about 4 to 8, or about 4 to 6, or about 2, 3, 4, 5, 6, or more than about 6 AlexaFluor 647 molecules molecule attached an antibody, e.g., a goat polyclonal anti-cTnl antibody, specific for amino acids 27-41 of human cTnI.
  • an antibody e.g., a goat polyclonal anti-cTnl antibody, specific for amino acids 27-41 of human cTnI.
  • a composition for the detection of cardiac troponin I that includes an average of 1 to 11, or about 2 to 10, or about 2 to 8, or about 2 to 6, or about 2 to 5, or about 2 to 4, or about 3 to 10, or about 3 to 8, or about 3 to 6, or about 3 to 5, or about 4 to 10, or about 4 to 8, or about 4 to 6, or about 2, 3, 4, 5, 6, or more than about 6 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • an antibody e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • composition for the detection of cardiac troponin I that includes an average of about 2 to 10 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • a composition for the detection of cardiac troponin I that includes an average of about 2 to 8 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • a composition for the detection of cardiac troponin I that includes an average of about 2 to 6 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • a composition for the detection of cardiac troponin I that includes an average of about 2 to 4 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • composition for the detection of cardiac troponin I that includes an average of about 3 to 8 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • a composition for the detection of cardiac troponin I that includes an average of about 3 to 6 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • composition for the detection of cardiac troponin I that includes an average of about 4 to 8 AlexaFluor 647 molecules molecule attached to an antibody, e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • an antibody e.g., a goat polyclonal anti-cTnI antibody, specific for amino acids 27-41 of human cTnI.
  • Attachment of the fluorescent moiety, or fluorescent entities that make up the fluorescent moiety, to the binding partner, e.g., antibody, may be by any suitable means; such methods are well-known in the art and exemplary methods are given in the Examples.
  • an antibody-dye label may be filtered prior to use, e.g., through a 0.2 micron filter, or any suitable filter for removing aggregates.
  • reagents for use in the assays may also be filtered, e.g., e.g., through a 0.2 micron filter, or any suitable filter. Without being bound by theory, it is thought that such filtration removes a portion of the aggregates of the, e.g., antibody-dye labels. As such aggregates will bind as a unit to the protein of interest, but upon release in elution buffer are likely to disaggregate, false positives may result; i.e., several labels will be detected from an aggregate that has bound to only a single protein molecule of interest. Regardless of theory, filtration has been found to reduce false positives in the subsequent assay and to improve accuracy and precision.
  • Disclosed herein, but not an aspect of the invention is a method for determining the the presence or absence of a single molecule of cardiac troponin or a fragment or complex thereof in a sample, by i) labeling the molecule, fragment, or complex, if present, with a label; and ii) detecting the presence or absence of the label, where the detection of the presence of the label indicates the presence of the single molecule, fragment, or complex of cardiac troponin in the sample.
  • molecule of cardiac troponin includes a molecule that contains substantially the entire naturally-occurring amino acid sequence of the particular type of cardiac troponin, including post-translationally modified forms, e.g., phosphorylated forms, as well as oxidized or otherwise chemically altered forms.
  • a "fragment" of a molecule includes a molecule of cardiac troponin that contains less than the entire naturally-occurring amino acid sequence, including modifications as for the entire molecule.
  • a "complex" of a molecule of cardiac troponin includes a molecule of cardiac troponin or a fragment that is associated with one or more other molecules or substances, e.g., that is associated with one or more other molecules of cardiac troponin.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 100, 80, 60, 50, 40, 30, 20,15,12,10,9,8, 7, 6, 5, 4, 3, 2, 1, 0.9, 0.8, 0.7, 0.6, 0.5, 0.4, 0.3, 0.2. or 0.1 pg/ml.
  • the method is capable of detecting the troponin at a limit of detection of less than about 100 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 50 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 20 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 10 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 5 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 3 pg/ml.
  • the method may be capable of detecting the troponin at a limit of detection of less than about 1 pg/ml. Detection limits may be determined by use of the appropriate National Institute of Standards and Technology reference standard material, e.g., standard cTnI.
  • the methods also provide methods of determining a concentration of cardiac troponin in a sample by detecting single molecules of troponin in the sample.
  • the "detecting" of a single molecule of troponin includes detecting the molecule directly or indirectly.
  • labels that corresponds to single molecules of cardiac troponin e.g., a labels that have been attached to the single molecules of cardiac troponin, may be detected.
  • Types of cardiac troponin for detection are as described herein, e.g., cTnI, total cardiac troponin (e.g., total cTnI) or free, complexed, or fragments of cardiac troponin.
  • total cTnI is detected and/or quantitated.
  • the sample may be a plasma sample or a serum sample from blood.
  • the sample is a biological fluid.
  • fluids include exhaled breath condensate (EBC), bronchoalveolar lavage fluid (BAL), blood, serum, plasma, urine, cerebrospinal fluid, pleural fluid, synovial fluid, peritoneal fluid, amniotic fluid, gastric fluid, lymph fluid, interstitial fluid, tissue homogenate, cell extracts, saliva, sputum, stool, physiological secretions, tears, mucus, sweat, milk, semen, seminal fluid, vaginal secretions, fluid from ulcers and other surface eruptions, blisters, and abscesses, and extracts of tissues including biopsies of normal, malignant, and suspect tissues or any other constituents of the body which may contain the target particle of interest.
  • Other similar specimens such as cell or tissue culture or culture broth are also of interest.
  • the sample is a plasma sample. In some embodiments the sample is a serum sample.
  • sample preparation in which a label is added to one or more particles may be performed in a homogeneous or heterogeneous format.
  • sample preparation in which a label is added to one or more particles may be performed in a homogeneous or heterogeneous format.
  • the sample preparation is formed in a homogenous format.
  • unbound label is not removed from the sample. See, e.g., U.S. Patent Application No. 11/048,660 .
  • the particle or particles of interest are labeled by addition of labeled antibody or antibodies that bind to the particle or particles of interest.
  • a heterogeneous assay format is used, where, typically, a step is employed for removing unbound label.
  • assay formats are well-known in the art.
  • One particularly useful assay format is a sandwich assay, e.g., a sandwich immunoassay.
  • the molecule of interest e.g., marker of a biological state
  • the capture binding partner e.g., a capture binding partner for capturing unbound label.
  • Unwanted molecules and other substances may then optionally be washed away, followed by binding of a label comprsing a detection binding partner and a detectable label, e.g., fluorescent moiety.
  • sample and label are added to the capture binding partner without a wash in between, e.g., at the same time.
  • a method for detecting troponin particles may use a sandwich assay with antibodies, e.g., monoclonal antibodies as capture binding partners.
  • the method comprises binding troponin molecules in a sample to a capture antibody that is immobilized on a binding surface, and binding the detection antibody to the troponin molecule to form a "sandwich" complex.
  • the detection antibody comprises a detectable fluorescent label, as described herein, which is detected, e.g., using the single molecule analyzers disclosed herein. Both the capture and detection antibodies specifically bind troponin.
  • sandwich immunoassays are known, and some are described in U.S. Pat. No. 4,168,146 to Grubb et al. and U.S. Pat. No. 4,366,241 to Tom et al. Further examples specific to cardiac troponin are described in the Examples.
  • the capture binding partner may be attached to a solid support, e.g., a microtiter plate or paramagnetic beads.
  • a binding partner for a cardiac troponin may be attached to a paramagnetic bead. Any suitable binding partner that is specific for the type of cardiac troponin that it is wished to capture may be used.
  • the binding partner may be an antibody, e.g., a monoclonal antibody.
  • the antibody may be specific for free cardiac troponin (cTnI) or for complexed cardiac troponin, modified cardiac troponin, or fragments of cardiac troponin, as described herein, or specific to all or substantially all forms of cTnI likely to be found in the sample of interest.
  • antibodies for measuring total troponin are those that not substantially affected by heparin, phosphorylation, oxidation and troponin complex formation, and that do not cross-react with skeletal muscle troponin, e.g., troponin I.
  • the antibody is specific for a specific region of a cardiac troponin.
  • the region includes amino acids 41-49 of human cardiac troponin I.
  • the region includes amino acids 87-91 of human cardiac troponin I.
  • Such antibodies are well-known in the art and are available from, e.g. BiosPacific, Emeryville, CA.
  • An example of a capture antibody useful in embodiments of the invention is an antibody, e.g., a monoclonal antibody, that reacts with free cardiac troponin I (cTnI) a.a. 41-49 and cTnI forming complexes with other troponin components.
  • this antibody is not affected by heparin, phosphorylation, oxidation and troponin complex formation, and does not cross-react with skeletal muscle troponin I.
  • An exemplary antibody of this type is Monoclonal Antibody Clone Number A34650228P, available from Bios Pacific, Emeryville, CA.
  • a capture antibody useful in embodiments of the invention is an antibody, e.g., a monoclonal antibody, that reacts with free cardiac troponin I (cTnI) a.a. 87-91 and cTnI forming complexes with other troponin components.
  • this antibody is not affected by heparin, phosphorylation, oxidation and troponin complex formation, and does not cross-react with skeletal muscle troponin I.
  • An exemplary antibody of this type is Monoclonal Antibody Clone Number A34440228P, available from Bios Pacific, Everyville, CA. It will be appreciated that antibodies identified herein as useful as a capture antibody may also be useful as detection antibodies, and vice versa.
  • the attachment of the binding partner, e.g., antibody, to the solid support may be covalent or noncovalent.
  • the attachment is noncovalent.
  • An example of a noncovalent attachment well-known in the art is biotin-avidin/streptavidin interactions.
  • a solid support e.g., a microtiter plate or a paramagnetic bead, is attached to the capture binding partner, e.g., antibody, through noncovalent attachment, e.g., biotin-avidin/streptavidin interactions.
  • the attachment is covalent.
  • a solid support e.g., a microtiter plate or a paramagnetic bead
  • the capture binding partner e.g., antibody
  • covalent attachment in which the orientation of the capture antibody is such that capture of the molecule of interest is optimized is especially useful.
  • a solid support e.g., a microtiter plate or a paramagnetic microparticle, may be used in which the attachment of the binding partner, e.g., antibody, is an oriented attachment, e.g., a covalent oriented attachment.
  • An exemplary protocol for oriented attachment of an antibody to a solid support is as follows: IgG is dissolved in 0.1M sodium acetate buffer, pH 5.5 to a final concentration of 1 mg/ml. An equal volume of ice-cold 20 mM sodium periodate in 0.1 M sodium acetate, pH 5.5 is added. The IgG is allowed to oxidize for 1 ⁇ 2 hour on ice. Excess periodate reagent is quenched by the addition of 0.15 volume of 1 M glycerol. Low molecular weight byproducts of the oxidation reaction are removed by ultrafiltration.
  • the oxidized IgG fraction is diluted to a suitable concentration (typically 0.5 micrograms IgG per ml) and reacted with hydrazide-activated multiwell plates for at least two hours at room temperature. Unbound IgG is removed by washing the multiwell plate with borate buffered saline or another suitable buffer. The plate may be dried for storage, if desired. A similar protocol may be followed for microbeads if the material of the microbead is suitable for such attachment.
  • the solid support is a microtiter plate. In some embodiments, the solid support is a paramagnetic bead.
  • An exemplary paramagnetic bead is Streptavidin C1(Dynal, 650.01-03).
  • Other suitable beads will be apparent to those of skill in the art. Methods for attachment of antibodies to paramagnetic beads are well-known in the art. One example is given in the Examples.
  • the cardiac troponin of interest is contacted with the capture binding partner, e.g., capture antibody immobilized on a solid support.
  • the capture binding partner e.g., capture antibody immobilized on a solid support.
  • Some sample preparation may be used; e.g., preparation of serum from blood samples or concentration procedures before the sample is contacted with the capture antibody. Protocols for binding of proteins in immunoassays are well-known in the art and are included in the Examples.
  • the time allowed for binding will vary depending on the conditions; it will be apparent that shorter binding times are desirable in some settings, especially in a clinical setting.
  • the use of, e.g., paramagnetic beads can reduce the time required for binding.
  • the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody is less that about 12, 10, 8, 6, 4, 3, 2, or 1 hours, or less than about 60, 50, 40, 30, 25, 20, 15, 10, or 5 minutes.
  • the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody is less than about 60 minutes.
  • the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody is less that about 40 minutes.
  • the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody is less that about 30 minutes. In some embodiments, the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody, is less that about 20 minutes. In some embodiments, the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody, is less that about 15 minutes. In some embodiments, the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody, is less that about 10 minutes. In some embodiments, the time allowed for binding of the protein of interest to the capture binding partner, e.g., antibody, is less that about 5 minutes.
  • the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest is less that about 12, 10, 8, 6, 4, 3, 2, or 1 hours, or less than about 60, 50, 40, 30, 25, 20, 15, 10, or 5 minutes.
  • the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest is less that about 60 minutes. In some embodiments, the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest, is less than about 40 minutes. In some embodiments, the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest, is less than about 30 minutes. In some embodiments, the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest, is less than about 20 minutes.
  • the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest is less than about 15 minutes. In some embodiments, the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest, is less than about 10 minutes. In some embodiments, the time allowed for both binding of the protein of interest to the capture binding partner, e.g., antibody, and binding of the label to the protein of interest, is less than about 5 minutes.
  • Some immunoassay diagnostic reagents including the capture and signal antibodies used to measure the target analytes may be derived from the sera of animals. Endogenous human heterophilic antibodies, or human anti-animal antibodies, which have the ability to bind to immunoglobulins of other species, are present in the serum or plasma of more than 10% of patients. These circulating heterophile antibodies may interfere with immunoassay measurements. In sandwich immunoassays, these heterophilic antibodies can either bridge the capture and detection (diagnostic) antibodies, thereby producing a false-positive signal, or they may block the binding of the diagnostic antibodies, thereby producing a false-negative signal. In competitive immunoassays, the heterophile antibodies may bind to the analytic antibody and inhibit its binding to the troponin.
  • the immunoassay includes the step of depleting the sample of heterophile antibodies using one or more heterophile antibody blockers.
  • Methods for removing heterophile antibodies from samples that are to be tested in immunoassays include: heating the specimen in a sodium acetate buffer, pH 5.0, for 15 minutes at 90°C and centrifuging at 1200g for 10 minutes, or the heterophile antibodies can be precipitated using polyethylene glycol (PEG); immunoextracting the interfering heterophile immunoglobulins from the specimen using protein A or protein G; or adding nonimmune mouse IgG.
  • PEG polyethylene glycol
  • Embodiments of the methods of the invention contemplate preparing the sample prior to analysis with the single molecule detector. The appropriateness of the method of pretreatment may be determined. Biochemicals to minimize immunoassay interference caused by heterophile antibodies are commercially available.
  • a product called MAK33 which is an IgG1 monoclonal antibody to h-CK-MM, may be obtained from Boehringer Mannheim.
  • the MAK33 plus product contains a combination ofIgG 1 and IgG1-Fab.
  • the polyMAK33 contains IgGl-Fab polymerized with IgG1, and the polyMAC 2b/2a contains IgG2a-Fab polymerized with IgG2b.
  • a second commercial source of biochemicals to neutralize heterophile antibodies is Immunoglobulin Inhibiting Reagent marketed by Bioreclamation Inc, East Meadow, NY.
  • This product is a preparation of immunoglobulins (IgG and IgM) from multiple species, mainly murine IgG2a, IgG2b, and IgG3 from Balb/c mice.
  • the heterophile antibody may be immunoextracted from the sample using methods known in the art e.g. depleting the sample of the heterophile antibody by binding the interfering antibody to protein A or G.
  • the heterophile antibody is neutralized using one or more heterophile antibody blockers.
  • Heterophile blockers may be selected from the group consisting of anti-isotype heterophile antibody blockers, anti-idiotype heterophile antibody blockers, and anti-anti-idiotype heterophile antibody blockers. In some embodiments a combination of heterophile antibody blockers may be used.
  • Label is added either with or following the addition of sample and washing. Protocols for binding of antibody and other immunolabels to proteins and other molecules are well-known in the art. If the label binding step is separate from capture binding, the time allowed for label binding can be important, e.g., in the clinical setting. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 12, 10, 8, 6, 4, 3, 2, or 1 hours, or less than about 60, 50, 40, 30, 25, 20, 15, 10, or 5 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 60 minutes.
  • the time allowed for binding of the protein of interest to the label is less than about 40 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 30 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 20 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 15 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 10 minutes. In some embodiments, the time allowed for binding of the protein of interest to the label, e.g., antibody-dye, is less than about 5 minutes. Excess label is removed by washing.
  • Elution buffers of use in the invention include a chaotrope, e.g., urea or a guanidinium compound; a buffer, e.g., borate buffered saline; a protein carrier, e.g., an albumin, such as human, bovine, or fish albumin, or an IgG, to coat the wall of the capillary tube in the detection instrument; and a surfactant, e.g., an ionic or nonionic detergent, selected so as to produce a relatively low background, e.g., Tween 20, Triton X-100, or SDS.
  • a chaotrope e.g., urea or a guanidinium compound
  • a buffer e.g., borate buffered saline
  • a protein carrier e.g., an albumin, such as human, bovine, or fish albumin, or an IgG
  • a surfactant e.g., an
  • the elution buffer/label aliquot that is sampled into the single molecule detector is referred to as the "processing sample,” to distinguish it from the original sample which was obtained from an individual.
  • the solid phase binding assay may employ a competitive binding assay format.
  • One such method comprises a) competitively binding to a capture antibody immobilized on a binding surface i) a troponin particle in a sample and ii) a labeled analog of the troponin particle comprising a detectable label (the detection reagent) and b) measuring the amount of the label using a single particle analyzer.
  • Another such method comprises a) competitively binding to an antibody having a detectable label (the detection reagent) i) a troponin particle in a sample and ii) an analog of troponin particle that is immobilized on a binding surface (the capture reagent) and b) measuring the amount of the label using a single particle analyzer.
  • an "analog of a troponin” refers, herein, to a species that competes with troponin for binding to a capture antibody. Examples of competitive immunoassays are disclosed in U.S. Pat. No. 4,235,601 to Deutsch et al. , U.S. Pat. No. 4,442,204 to Liotta , and U.S. Pat. No. 5,208,535 to Buechler et al.
  • a processing sample may contain no label, a single label, or a plurality of labels.
  • the number of labels corresponds or is proportional to (if dilutions or fractions of samples are used) the number of molecules of cardiac troponin captured during the capture step.
  • any suitable single molecule detector capable of detecting the label used with the protein of interest may be used. Suitable single molecule detectors are described herein. Typically the detector will be part of a system that includes an automatic sampler for sampling prepared samples, and, optionally, a recovery system to recover samples.
  • the processing sample is analyzed in a single molecule analyzer that utilizes a capillary flow system, and that includes a capillary flow cell, a laser to illuminate an interrogation space in the capillary through which processing sample is passed, a detector to detect radiation emitted from the interrogation space, and a source of motive force to move a processing sample through the interrogation space.
  • the single molecule analyzer further comprises a microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space, e.g., a high numerical aperture microscope objective.
  • the laser and detector are in a confocal arrangement.
  • the laser is a continuous wave laser.
  • the detector is a avalanche photodiode detector.
  • the source of motive force is a pump to provide pressure.
  • an analyzer system that includes a sampling system capable of automatically sampling a plurality of samples providing a fluid communication between a sample container and the interrogation space.
  • the interrogation space has a volume of between about 0.001 and 500 pL, or between about 0.01 pL and 100 pL, or between about 0.01 pL and 10 pL, or between about 0.01 pL and 5 pL, or between about 0.01 pL and 0.5 pL, or between about 0.02 pL and about 300 pL, or between about 0.02 pL and about 50 pL or between about 0.02 pL and about 5 pL or between about 0.02 pL and about 0.5 pL or between about 0.02 pL and about 2 pL, or between about 0.05 pL and about 50 pL, or between about 0.05 pL and about 5 pL, or between about 0.05 pL and about 0.5 pL, or between about 0.05 pL and about 0.2 pL or between about 0.1 pL and about 25 pL.
  • the interrogation space has a volume between about 0.004 pL and 100 pL. In some embodiments, the interrogation space has a volume between about 0.02 pL and 50 pL. In some embodiments, the interrogation space has a volume between about 0.001 pL and 10 pL. In some embodiments, the interrogation space has a volume between about 0.001 pL and 10 pL. In some embodiments, the interrogation space has a volume between about 0.01 pL and 5 pL. In some embodiments, the interrogation space has a volume between about 0.02 pL and about 5 pL.
  • the interrogation space has a volume between about 0.05 pL and 5 pL In some embodiments, the interrogation space has a volume between about 0.05 pL and 10 pL. In some embodiments, the interrogation space has a volume between about 0.5 pL and about 5 pL. In some embodiments, the interrogation space has a volume between about 0.02 pL and about 0.5 pL.
  • the single molecule detector used in the methods of the invention utilizes a capillary flow system, and includes a capillary flow cell, a continuous wave laser to illuminate an interrogation space in the capillary through which processing sample is passed, a high numerical aperture microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space, an avalanche photodiode detector to detect radiation emitted from the interrogation space, and a pump to provide pressure to move a processing sample through the interrogation space, where the interrogation space is between about 0.02 pL and about 50 pL.
  • the single molecule detector used in the methods of the invention utilizes a capillary flow system, and includes a capillary flow cell, a continuous wave laser to illuminate an interrogation space in the capillary through which processing sample is passed, a high numerical aperture microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space wherein the lens has a numerical aperture of at least about 0.8, an avalanche photodiode detector to detect radiation emitted from the interrogation space, and a pump to provide pressure to move a processing sample through the interrogation space, where the interrogation space is between about 0.004 pL and about 100 pL.
  • the single molecule detector used in the methods of the invention utilizes a capillary flow system, and includes a capillary flow cell, a continuous wave laser to illuminate an interrogation space in the capillary through which processing sample is passed, a high numerical aperture microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space wherein the lens has a numerical aperture of at least about 0.8, an avalanche photodiode detector to detect radiation emitted from the interrogation space, and a pump to provide pressure to move a processing sample through the interrogation space, where the interrogation space is between about 0.05 pL and about 10 pL.
  • the single molecule detector used in the methods of the invention utilizes a capillary flow system, and includes a capillary flow cell, a continuous wave laser to illuminate an interrogation space in the capillary through which processing sample is passed, a high numerical aperture microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space wherein the lens has a numerical aperture of at least about 0.8, an avalanche photodiode detector to detect radiation emitted from the interrogation space, and a pump to provide pressure to move a processing sample through the interrogation space, where the interrogation space is between about 0.05 pL and about 5 pL.
  • the single molecule detector used in the methods of the invention utilizes a capillary flow system, and includes a capillary flow cell, a continuous wave laser to illuminate an interrogation space in the capillary through which processing sample is passed, a high numerical aperture microscope objective lens that collects light emitted from processing sample as it passes through the interrogation space wherein the lens has a numerical aperture of at least about 0.8, an avalanche photodiode detector to detect radiation emitted from the interrogation space, and a pump to provide pressure to move a processing sample through the interrogation space, where the interrogation space is between about 0.5 pL and about 5 pL.
  • the single molecule detector is capable of determining a concentration for a molecule of interest in a sample where sample may range in concentration over a range of at least about 100-fold, or 1000-fold, or 10,000-fold, or 100,000-fold, or 300,00-fold, or 1,000,000-fold, or 10,000,000-fold, or 30,000,000-fold.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 50%, 40%, 30%, 20%, 15%, or 10% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 100, 90, 80, 70, 60, 50, 40, 30, 20, 15, 10, 5, 4, 3, 2, or 1 ul, and wherein the analyte is present at a concentration of less than about 100, 90, 80, 70, 60, 50, 40, 30, 20, 15, 10, 5, 4, 3, 2, or 1 femtomolar.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 50% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 100 ul, and wherein the analyte is present at a concentration of less than about 100 femtomolar.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 40% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 50 ul, and wherein the analyte is present at a concentration of less than about 50 femtomolar.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 20% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 20 ul, and wherein the analyte is present at a concentration of less than about 20 femtomolar.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 20% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 10 ul, and wherein the analyte is present at a concentration of less than about 10 femtomolar.
  • the methods of the invention utilize a single molecule detector capable detecting a difference of less than about 20% in concentration of an analyte between a first sample and a second sample that are introduced into the detector, where the volume of the first sample and said second sample introduced into the analyzer is less than about 5 ul, and wherein the analyte is present at a concentration of less than about 5 femtomolar.
  • single molecule detector and systems are described in more detail below.
  • Further single molecule analyzers useful in the methods of the invention such as detectors with more than one interrogation window, detectors utilize electrokinetic or electrophoretic flow, and the like, may be found in U.S. Patent Application No. 11/048,660 .
  • a wash buffer that maintains the salt and surfactant concentrations of the sample may be used in some embodiments to maintain the conditioning of the capillary; i.e., to keep the capillary surface relatively constant between samples to reduce variability.
  • a feature that contributes to the extremely high sensitivity of the methods of the invention is the method of detecting and counting labels, which, in some embodiments, are attached to single molecules to be detected or, more typically, correspond to a single molecule to be detected.
  • the processing sample flowing through the capillary is effectively divided into a series of detection events, by subjecting a given interrogation space of the capillary to EM radiation from a laser that emits light at an appropriate excitation wavelength for the fluorescent moiety used in the label for a predetermined period of time, and detecting photons emitted during that time.
  • Each predetermined period of time is a "bin.” If the total number of photons detected in a given bin exceeds a predetermined threshold level, a detection event is registered for that bin, i.e., a label has been detected. If the total number of photons is not at the predetermined threshold level, no detection event is registered.
  • processing sample concentration is dilute enough that, for a large percentage of detection events, the detection event represents only one label passing through the window, which corresponds to a single molecule of interest in the original sample, that is, few detection events represent more than one label in a single bin.
  • further refinements are applied to allow greater concentrations of label in the processing sample to be detected accurately, i.e., concentrations at which the probability of two or more labels being detected as a single detection event is no longer insignificant.
  • the bin times are selected in the range of about 1 microsecond to about 5 ms. In some embodiments, the bin time is more than about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 250, 300, 400, 500, 600, 700, 750, 800, 900, 1000, 2000, 3000, 4000, or 5000 microseconds..
  • the bin time is less than about 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 250, 300, 400, 500, 600, 700, 750, 800, 900, 1000, 2000, 3000, 4000, or 5000 microseconds. In some embodiments, the bin time is about 1 to 1000 microseconds. In some embodiments, the bin time is about 1 to 750 microseconds. In some embodiments, the bin time is about 1 to 500 microseconds. In some embodiments, the bin time is about 1 to 250 microseconds. In some embodiments, the bin time is about 1 to 100 microseconds. In some embodiments, the bin time is about 1 to 50 microseconds.
  • the bin time is about 1 to 40 microseconds. In some embodiments, the bin time is about 1 to 30 microseconds. In some embodiments, the bin time is about 1 to 500 microseconds. In some embodiments, the bin time is about 1 to 20 microseconds. In some embodiments, the bin time is about 1 to 10 microseconds. In some embodiments, the bin time is about 1 to 500 microseconds. In some embodiments, the bin time is about 1 to 5 microseconds. In some embodiments, the bin time is about 5 to 500 microseconds. In some embodiments, the bin time is about 5 to 250 microseconds. In some embodiments, the bin time is about 5 to 100 microseconds. In some embodiments, the bin time is about 5 to 50microseconds.
  • the bin time is about 5 to 20 microseconds. In some embodiments, the bin time is about 5 to 10 microseconds. In some embodiments, the bin time is about 10 to 500 microseconds. In some embodiments, the bin time is about 10 to 250 microseconds. In some embodiments, the bin time is about 10 to 100 microseconds. In some embodiments, the bin time is about 10 to 50 microseconds. In some embodiments, the bin time is about 10 to 30 microseconds. In some embodiments, the bin time is about 10 to 20 microseconds. In some embodiments, the bin time is about 5 microseconds. In some embodiments, the bin time is about 5 microseconds. In some embodiments, the bin time is about 6 microseconds.
  • the bin time is about 7 microseconds. In some embodiments, the bin time is about 8 microseconds. In some embodiments, the bin time is about 9 microseconds. In some embodiments, the bin time is about 10 microseconds. In some embodiments, the bin time is about 11 microseconds. In some embodiments, the bin time is about 12 microseconds. In some embodiments, the bin time is about 13 microseconds. In some embodiments, the bin time is about 14 microseconds. In some embodiments, the bin time is about 5 microseconds. In some embodiments, the bin time is about 15 microseconds. In some embodiments, the bin time is about 16 microseconds. In some embodiments, the bin time is about 17 microseconds.
  • the bin time is about 18 microseconds. In some embodiments, the bin time is about 19 microseconds. In some embodiments, the bin time is about 20 microseconds. In some embodiments, the bin time is about 25 microseconds. In some embodiments, the bin time is about 30 microseconds. In some embodiments, the bin time is about 40 microseconds. In some embodiments, the bin time is about 50 microseconds. In some embodiments, the bin time is about 100 microseconds. In some embodiments, the bin time is about 250 microseconds. In some embodiments, the bin time is about 500 microseconds. In some embodiments, the bin time is about 750 microseconds. In some embodiments, the bin time is about 1000 microseconds.
  • the background noise level is determined from the mean noise level, or the root-mean-square noise. In other cases, a typical noise value or a statistical value is chosen. In most cases, the noise is expected to follow a Poisson distribution. Thus, in some embodiments, determining the concentration of a particle-label complex in a sample comprises determining the background noise level.
  • a label flows through the capillary flow cell, it is irradiated by the laser beam to generate a burst of photons.
  • the photons emitted by the label are discriminated from background light or background noise emission by considering only the bursts of photons that have energy above a predetermined threshold energy level which accounts for the amount of background noise that is present in the sample.
  • Background noise typically comprises low frequency emission produced, for example, by the intrinsic fluorescence of non-labeled particles that are present in the sample, the buffer or diluent used in preparing the sample for analysis, Raman scattering and electronic noise.
  • the value assigned to the background noise is calculated as the average background signal noise detected in a plurality of bins, which are measurements of photon signals that are detected in an interrogation space during a predetermined length of time.
  • background noise is calculated for each sample as a number specific to that sample.
  • the threshold energy level can be assigned.
  • the threshold value is determined to discriminate true signals (due to fluorescence of a label) from the background noise. Care must be taken in choosing a threshold value such that the number of false positive signals from random noise is minimized while the number of true signals which are rejected is also minimized:
  • Methods for choosing a threshold value include determining a fixed value above the noise level and calculating a threshold value based on the distribution of the noise signal.
  • the threshold is set at a fixed number of standard deviations above the background level. Assuming a Poisson distribution of the noise, using this method one can estimate the number of false positive signals over the time course of the experiment.
  • the threshold level is calculated as a value of 4 sigma above the background noise. For example, given an average background noise level of 200 photons, the analyzer system establishes a threshold level of 4 ⁇ 200 above the average background/noise level of 200 photons to be 256 photons.
  • determining the concentration of a label in a sample includes establishing the threshold level above which photon signals represent the presence of a label. Conversely, photon signals that have an energy level that is not greater than that of the threshold level indicate the absence of a label.
  • bin measurements are taken to determine the concentration of a sample, and the absence or presence of a label is ascertained for each bin measurement.
  • 60,000 measurements or more can made in one minute (e.g., in embodiments in which the bin size is 1ms-for smaller bin sizes the number of measurements is correspondingly larger, e.g., 6,000,000 measurements per minute for a bin size of 10 microseconds).
  • no single measurement is crucial and the method provides for a high margin of error.
  • the bins that are determined not to contain a label (“no" bins) are discounted and only the measurements made in the bins that are determined to contain label (“yes” bins) are accounted in determining the concentration of the label in the processing sample.
  • determining the concentration of a label in a sample comprises detecting the bin measurements that reflect the presence of a label.
  • the signal to noise ratio or the sensitivity of the analyzer system can be increased by minimizing the time that background noise is detected during a bin measurement in which a particle-label complex is detected. For example, in a bin measurement lasting 1 millisecond during which one particle-label complex is detected when passing across an interrogation space within 250 microseconds, 750 microseconds of the 1 millisecond are spent detecting background noise emission.
  • the signal to noise ratio can be improved by decreasing the bin time.
  • the bin time is 1 millisecond. In other embodiments, the bin time is 750, 500, 250 microseconds, 100 microseconds, 50 microseconds, 25 microseconds or 10 microseconds. Other bin times are as described herein.
  • the bin time is adjusted without changing the flow rate. It will be appreciated by those of skill in the art that as bin time decreases, laser power output directed at the interrogation space must increase to maintain a constant total energy applied to the interrogation space during the bin time. For example, if bin time is decreased from 1000 microseconds to 250 microseconds, as a first approximation, laser power output must be increased approximately four-fold.
  • the interrogation space encompasses the entire cross-section of the sample stream.
  • the interrogation space encompasses the entire cross-section of the sample stream, only the number of labels counted and the volume passing through a cross-section of the sample stream in a set length of time are needed to calculate the concentration of the label in the processing sample.
  • the interrogation space can be defined to be smaller than the cross-sectional area of sample stream by, for example, the interrogation space is defined by the size of the spot illuminated by the laser beam.
  • the interrogation space can be defined by adjusting the apertures 306 ( Figure 1A ) or 358 and 359 ( Figure 1B ) of the analyzer and reducing the illuminated volume that is imaged by the objective lens to the detector.
  • the concentration of the label can be determined by interpolation of the signal emitted by the complex from a standard curve that is generated using one or more samples of known standard concentrations.
  • the concentration of the label can be determined by comparing the measured particles to an internal label standard.
  • the dilution factor is accounted in calculating the concentration of the molecule of interest in the starting sample.
  • determining the concentration of a label in a processing sample comprises determining the total number of labels detected "yes" bins and relating the total number of detected labels to the total sample volume that was analyzed.
  • the total sample volume that is analyzed is the sample volume that is passed through the capillary flow cell and across the interrogation space in a specified time interval.
  • the concentration of the label complex in a sample is determined by interpolation of the signal emitted by the label in a number of bins from a standard curve that is generated by determining the signal emitted by labels in the same number of bins by standard samples containing known concentrations of the label.
  • the number of individual labels that are detected in a bin is related to the relative concentration of the particle in the processing sample. At relatively low concentrations, for example at concentrations below about 10 -16 M the number of labels is proportional to the photon signal that is detected in a bin. Thus, at low concentrations of label the photon signal is provided as a digital signal. At relatively higher concentrations, for example at concentrations greater than about 10 -16 M, the proportionality of photon signal to a label is lost as the likelihood of two or more labels crossing the interrogation space at about the same time and being counted as one becomes significant. Thus, in some embodiments, individual particles in a sample of a concentration greater than about 10 -16 M are resolved by decreasing the length of time of the bin measurement.
  • the total the photon signal that is emitted by a plurality of particles that are present in any one bin is detected!.
  • the dynamic range is at least 3, 3.5, 4, 4.5, 5.5, 6, 6.5, 7, 7.5, 8, or more than 8 logs.
  • “Dynamic range,” as that term is used herein, refers to the range of sample concentrations that may be quantitated by the instrument without need for dilution or other treatment to alter the concentration of successive samples of differing concentrations, where concentrations are determined with an accuracy appropriate for the intended use.
  • a microtiter plate contains a sample of 1 femtomolar concentration for an analyte of interest in one well, a sample of 10,000 femtomolar concentration for an analyte of interest in another well, and a sample of 100 femtomolar concentration for the analyte in a third well
  • an instrument with a dynamic range of at least 4 logs and a lower limit of quantitation of 1 femtomolar is able to accurately quantitate the concentration of all the samples without the need for further treatment to adjust concentration, e.g., dilution.
  • Accuracy may be determined by standard methods, e.g., using a series of standards of concentrations that span the dynamic range and constructing a standard curve. Standard measures of fit of the resulting standard curve may be used as a measure of accuracy, e.g., an r 2 greater than about 0.7, 0.75, 0.8, 0.85, 0.9, 0.91, 0.92, 0.93, 0.94, 0.95, 0.96, 0.97, 0.98, or 0.99.
  • Increased dynamic range is achieved by altering the manner in which data from the detector is analyzed, and/or by the use of an attenuator between the detector and the interrogation space.
  • the data is analyzed to count detection events as single molecules. I.e., each bin is analyzed as a simple "yes” or "no" for the presence of label, as described above.
  • the number of event photons in a significant number of bins is found to be substantially greater than the number expected for a single label, e.g., the number of event photons in a significant number of bins corresponds to two-fold, three-fold, or more, than the number of event photons expected for a single label.
  • the instrument changes its method of data analysis to one of integrating the total number of event photons for the bins of the processing sample. This total will be proportional to the total number of labels that were in all the bins.
  • the instrument may include a data analysis system that receives input from the detector and determines the appropriate analysis method for the sample being run, and outputs values based on such analysis.
  • the data analysis system may further output instructions to use or not use an attenuator, if an attenuator is included in the instrument.
  • the instrument is capable of measuring concentrations of samples over a dynamic range of more than about 1000 (3 log), 10,000 (4 log), 100,000 (5 log), 350,000 (5.5 log), 1,000,000 (6 log), 3,500,000 (6.5 log), 10,000,000 (7 log), 35,000,000 (7.5 log), or 100,000,000 (8 log).
  • the instrument is capable of measuring concentrations of samples over a dynamic range of more than about 100,000 (5 log).
  • the instrument is capable of measuring concentrations of samples over a dynamic range of more than about 1,000,000 (6 log).
  • the instrument is capable of measuring concentrations of samples over a dynamic range of more than about 10,000,000 (7 log).
  • the instrument is capable of measuring the concentrations of samples over a dynamic range of from about 1-10 femtomolar to at least about 1000; 10,000; 100,000; 350,000; 1,000,000; 3,500,000; 10,000,000, or 35,000,000 femtomolar. In some embodiments, the instrument is capable of measuring the concentrations of samples over a dynamic range of from about 1-10 femtomolar to at least about 10,000 femtomolar. In some embodiments, the instrument is capable of measuring the concentrations of samples over a dynamic range of from about 1-10 femtomolar to at least about 100,000 femtomolar.
  • the instrument is capable of measuring the concentrations of samples over a dynamic range of from about 1-10 femtomolar to at least about 1,000,000 femtomolar. In some embodiments, the instrument is capable of measuring the concentrations of samples over a dynamic range of from about 1-10 femtomolar to at least about 10,000,000.
  • an analyzer or analyzer system is capable of detecting an analyte, e.g., a biomarker at a limit of detection of less than 1 nanomolar, or 1 picomolar, or 1 femtomolar, or 1 attomolar, or 1 zeptomolar.
  • an analyte e.g., a biomarker at a limit of detection of less than 1 nanomolar, or 1 picomolar, or 1 femtomolar, or 1 attomolar, or 1 zeptomolar.
  • the analyzer or analyzer system is capable of detecting a change in concentration of the analyte, or of multiple analytes, e.g., a biomarker or biomarkers, from one sample to another sample of less than about 0.1, 1, 2, 5, 10, 20, 30, 40, 50, 60, or 80% when the biomarker is present at a concentration of less than 1 nanomolar, or 1 picomolar, or 1 femtomolar, or 1 attomolar, or 1 zeptomolar, in the samples, and when the size of each of the sample is less than about 100, 50, 40, 30, 20, 10, 5, 2, 1, 0.1, 0.01, 0.001, or 0.0001 ul.
  • a biomarker or biomarkers e.g., a biomarker or biomarkers
  • the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 1 picomolar, and when the size of each of the samples is less than about 50 ⁇ l. In some embodiments, the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 100 femtomolar, and when the size of each of the samples is less than about 50 ⁇ l.
  • the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 50 femtomolar, and when the size of each of the samples is less than about 50 ⁇ l. In some embodiments, the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 5 femtomolar, and when the size of each of the samples is less than about 50 ⁇ l.
  • the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 5 femtomolar, and when the size of each of the samples is less than about 5 ⁇ l. In some embodiments, the analyzer or analyzer system is capable of detecting a change in concentration of the analyte from a first sample to a second sample of less than about 20%, when the analyte is present at a concentration of less than about 1 femtomolar, and when the size of each of the samples is less than about 5 ⁇ l.
  • the methods of the invention utilize analytical instruments of high sensitivity, e.g., single molecule detectors.
  • single molecule detectors include embodiments as hereinafter described.
  • the methods described herein utilize an analyzer system capable of detecting a single particle in a sample.
  • the analyzer system is capable of single particle detection of a fluorescently labeled particle wherein the analyzer system detects energy emitted by an excited fluorescent label in response to exposure by an electromagnetic radiation source when the single particle is present in an interrogation space defined within a capillary flow cell fluidly connected to the sampling system of the analyzer system.
  • the single particle moves through the interrogation space of the capillary flow cell by means of a motive force.
  • an automatic sampling system may be included in the analyzer system for introducing the sample into the analyzer system.
  • a sample preparation system may be included in the analyzer system for preparing a sample.
  • the analyzer system may contain a sample recovery system for recovering at least a portion of the sample after analysis is complete.
  • the analyzer system consists of an electromagnetic radiation source for exciting a single particle labeled with a fluorescent label.
  • the electromagnetic radiation source of the analyzer system is a laser.
  • the electromagnetic radiation source is a continuous wave laser.
  • the electromagnetic radiation source excites a fluorescent moiety attached to a label as the label passes through the interrogation space of the capillary flow cell.
  • the fluorescent label moiety inclues one or more fluorescent dye molecules.
  • the fluorescent label moiety is a quantum dot. Any fluorescent moiety as described herein may be used in the label.
  • a label is exposed to electromagnetic radiation when the label passes through an interrogation space located within the capillary flow cell.
  • the interrogation space is typically fluidly connected to a sampling system.
  • the label passes through the interrogation space of the capillary flow cell due to a motive force to advance the label through the analyzer system.
  • the interrogation space is positioned such that it receives electromagnetic radiation emitted from the radiation source.
  • the sampling system is an automated sampling system capable of sampling a plurality of samples without intervention from a human operator.
  • the label passes through the interrogation space and emits a detectable amount of energy when excited by the electromagnetic radiation source.
  • an electromagnetic radiation detector is operably connected to the interrogation space.
  • the electromagnetic radiation detector is capable of detecting the energy emitted by the label, e.g., by the fluorescent moiety of the label.
  • the system further includes a sample preparation mechanism where a sample may be partially or completely prepared for analysis by the analyzer system.
  • the sample is discarded after it is analyzed by the system.
  • the analyzer system further includes a sample recovery mechanism whereby at least a portion, or alternatively all or substantially all, of the sample may be recovered after analysis.
  • the sample can be returned to the origin of the sample.
  • the sample can be returned to microtiter wells on a sample microtiter plate.
  • the analyzer system typically further consists of a data acquisition system for collecting and reporting the detected signal.
  • the analyzer system 300 includes an electromagnetic radiation source 301, a mirror 302, a lens 303, a capillary flow cell 313, a microscopic objective lens 305, an aperture 306, a detector lens 307, a detector filter 308, a single photon detector 309, and a processor 310 operatively connected to the detector.
  • the electromagnetic radiation source 301 is aligned so that its output 311 is reflected off of a front surface 312 of mirror 302.
  • the lens 303 focuses the beam 311 onto a single interrogation space (an illustrative example of an interrogation space 314 is shown in Figure 2A ) in the capillary flow cell 313.
  • the microscope objective lens 305 collects light from sample particles and forms images of the beam onto the aperture 306.
  • the aperture 306 affects the fraction of light emitted by the specimen in the interrogation space of the capillary flow cell 313 that can be collected.
  • the detector lens 307 collects the light passing through the aperture 306 and focuses the light onto an active area of the detector 309 after it passes through the detector filters 308.
  • the detector filters 308 minimize aberrant noise signals due to light scatter or ambient light while maximizing the signal emitted by the excited fluorescent moiety bound to the particle.
  • the processor 310 processes the light signal from the particle according to the methods described herein.
  • the microscope objective lens 305 is a high numerical aperture microscope objective.
  • high numerical aperture lens include a lens with a numerical aperture of equal to or greater than 0.6.
  • the numerical aperture is a measure of the number of highly diffracted image-forming light rays captured by the objective. A higher numerical aperture allows increasingly oblique rays to enter the objective lens and thereby produce a more highly resolved image. Additionally, the brightness of an image increases with a higher numerical aperture.
  • High numerical aperture lenses are commercially available from a variety of vendors, and any one lens having a numerical aperture of equal to or greater than approximately 0.6 may be used in the analyzer system. In instances instances some instances, the lens has a numerical aperture of about 0.6 to about 1.3.
  • the lens has a numerical aperture of about 0.6 to about 1.0. In some instances, the lens has a numerical aperture of about 0.7 to about 1.2. In some instances, the lens has a numerical aperture of about 0.7 to about 1.0. In some instances, the lens has a numerical aperture of about 0.7 to about 0.9. In some instances, the lens has a numerical aperture of about 0.8 to about 1.3. In some instances, the lens has a numerical aperture of about 0.8 to about 1.2. In some instances, the lens has a numerical aperture of about 0.8 to about 1.0. In some instances, the lens has a numerical aperture of at least about 0.6. In some instances, the lens has a numerical aperture of at least about 0.7.
  • the lens has a numerical aperture of at least about 0.8. In some instances, the lens has a numerical aperture of at least about 0.9. In some instances, the lens has a numerical aperture of at least about 1.0. In some instances, the aperture of the microscope objective lens 305 is approximately 1.25. In an instance where a microscope objective lens 305 of 0.8 is used, a Nikon 60X/0.8 NA Achromat lens (Nikon, Inc., USA) can be used.
  • the electromagnetic radiation source 301 is a laser that emits light in the visible spectrum. In all instances, the electromagnetic radiation source is set such that wavelength of the laser is set such that it is of a sufficient wavelength to excite the fluorescent label attached to the particle.
  • the laser is a continuous wave laser with a wavelength of 639 nm. In other instances, the laser is a continuous wave laser with a wavelength of 532 nm. In other instances, the laser is a continuous wave laser with a wavelength of 422 nm. In other instances, the laser is a continuous wave laser with a wavelength of 405 nm. Any continuous wave laser with a wavelength suitable for exciting a fluorescent moiety as used in the methods of the invention may be used without departing from the scope of the invention.
  • a single particle analyzer system 300 As each particle passes through the beam 311 of the electromagnetic radiation source, the particle enters into an excited state. When the particle relaxes from its excited state, a detectable burst of light is emitted. The excitation-emission cycle is repeated many times by each particle in the length of time it takes for it to pass through the beam allowing the analyzer system 300 to detect tens to thousands of photons for each particle as it passes through an interrogation space 314. Photons emitted by fluorescent particles are registered by the detector 309 ( Figure 1A ) with a time delay indicative of the time for the particle label complex to pass through the interrogation space.
  • the photon intensity is recorded by the detector 309 and sampling time is divided into bins, which are uniform, arbitrary, time segments with freely selectable time channel widths. The number of signals contained in each bin evaluated.
  • One or a combination of several statistical analytical methods are employed in order to determine when a particle is present. Such methods include determining the baseline noise of the analyzer system and setting a signal strength for the fluorescent label at a statistical level above baseline noise to eliminate false positive signals from the detector.
  • the electromagnetic radiation source 301 is focused onto a capillary flow cell 313 of the analyzer system 300 where the capillary flow cell 313 is fluidly connected to the sample system.
  • An interrogation space 314 is shown in Figure 2A .
  • the beam 311 from the continuous wave electromagnetic radiation source 301 of Figure 1A is optically focused to a specified depth within the capillary flow cell 313.
  • the beam 311 is directed toward the sample-filled capillary flow cell 313 at an angle perpendicular to the capillary flow cell 313.
  • the beam 311 is operated at a predetermined wavelength that is selected to excite a particular fluorescent label used to label the particle of interest.
  • the size or volume of the interrogation space 314 is determined by the diameter of the beam 311 together with the depth at which the beam 311 is focused.
  • the interrogation space can be determined by running a calibration sample of known concentration through the analyzer system.
  • the beam size and the depth of focus required for single molecule detection are set and thereby define the size of the interrogation space 314.
  • the interrogation space 314 is set such that, with an appropriate sample concentration, only one particle is present in the interrogation space 314 during each time interval over which time observations are made.
  • the detection interrogation volume as defined by the beam is not perfectly spherically shaped, and typically is a "bow-tie" shape.
  • "volumes" of interrogation spaces are defined herein as the volume encompassed by a sphere of a diameter equal to the focused spot diameter of the beam.
  • the focused spot of the beam 311 may have various diameters without departing from the scope of the present invention.
  • the diameter of the focused spot of the beam is about 1 to about 5, 10, 15, or 20 microns, or about 5 to about 10, 15, or 20 microns, or about 10 to about 20 microns, or about 10 to about 15 microns.
  • the diameter of the focused spot of the beam is about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 microns.
  • the diameter of the focused spot of the beam is about 5 microns.
  • the diameter of the focused spot of the beam is about 10 microns.
  • the diameter of the focused spot of the beam is about 12 microns.
  • the diameter of the focused spot of the beam is about 13 microns. In some instances, the diameter of the focused spot of the beam is about 14 microns. In some instances, the diameter of the focused spot of the beam is about 15 microns. In some instances, the diameter of the focused spot of the beam is about 16 microns. In some instances, the diameter of the focused spot of the beam is about 17 microns. In some instances, the diameter of the focused spot of the beam is about 18 microns. In some embodiments, the diameter of the focused spot of the beam is about instances 19 microns. In some instances, the diameter of the focused spot of the beam is about 20 microns.
  • more than one electromagnetic radiation source can be used to excite particles labeled with fluorescent labels of different wavelengths.
  • more than one interrogation space in the capillary flow cell can be used.
  • multiple detectors can be employed to detect different emission wavelengths from the fluorescent labels.
  • a motive force is required to move a particle through the capillary flow cell 313 of the analyzer system 300.
  • the motive force can be a form of pressure.
  • the pressure used to move a particle through the capillary flow cell can be generated by a pump.
  • a Scivex, Inc. HPLC pump can be used.
  • the sample can pass through the capillary flow cell at a rate of 1 ⁇ L/min to about 20 ⁇ L/min, or about 5 ⁇ L/min to about 20 ⁇ L/min. In some instances, the sample can pass through the capillary flow cell at a rate of about 5 ⁇ L/min.
  • the sample can pass through the capillary flow cell at a rate of about 10 ⁇ L/min. In some instances, the sample can pass through the capillary flow cell at a rate of about 15 ⁇ L/min. In some instances, the sample can pass through the capillary flow cell at a rate of about 20 ⁇ L/min. In some instances instances, an electrokinetic force can be used to move the particle through the analyzer system. Such a method has been previously disclosed in previous U.S. Pat. App. No. 11/048,660 .
  • the detector 309 of the analyzer system detects the photons emitted by the fluorescent label.
  • the photon detector is a photodiode.
  • the detector is an avalanche photodiode detector.
  • the photodiodes can be silicon photodiodes with a wavelength detection of 190 nm and 1100 nm. When germanium photodiodes are used, the wavelength of light detected is between 400 nm to 1700 nm. In other instances, when an indium gallium arsenide photodiode is used, the wavelength of light detected by the photodiode is between 800 nm and 2600 nm. When lead sulfide photodiodes are used as detectors, the wavelength of light detected is between 1000 nm and 3500 nm.
  • the optics of the electromagnetic radiation source 301 and the optics of the detector 309 are arranged in a conventional optical arrangement. In such an arrangement, the electromagnetic radiation source and the detector are aligned on different focal planes.
  • the arrangement of the laser and the detector optics of the analyzer system as shown in Figures 1A and 1B is that of a conventional optical arrangement.
  • the optics of the electromagnetic radiation source and the optics of the detector are arranged in a confocal optical arrangement.
  • the electromagnetic radiation source 301 and the detector 309 are aligned on the same focal plane.
  • the confocal arrangement renders the analyzer more robust because the electromagnetic radiation source 301 and the detector optics 309 do not need to be realigned if the analyzer system is moved. This arrangement also makes the use of the analyzer more simplified because it eliminates the need to realign the components of the analyzer system.
  • the confocal arrangement for the analyzer 300 ( Figure 1A ) and the analyzer 355 ( Figure 1B ) are shown in Figures 3A and 3B respectively.
  • Figure 3A shows that the beam 311 from an electromagnetic radiation source 301 is focused by the microscope objective 315 to form one interrogation space 314 ( Figure 2A ) within the capillary flow cell 313.
  • a dichroic mirror 316 which reflects laser light but passes fluorescent light, is used to separate the fluorescent light from the laser light.
  • Filter 317 that is positioned in front of the detector eliminates any non-fluorescent light at the detector.
  • an analyzer system configured in a confocal arrangement can comprise two or more interrogations spaces. Such a in method has been previously disclosed in previous U.S. Pat. App. No. 11/048,660 .
  • the laser can be a tunable dye laser, such as a helium-neon laser.
  • the laser can be set to emit a wavelength of 632.8 nm.
  • the wavelength of the laser can be set to emit a wavelength of 543.5 nm or 1523 nm.
  • the electromagnetic laser can be an argon ion laser.
  • the argon ion laser can be operated as a continuous gas laser at about 25 different wavelengths in the visible spectrum, the wavelength set between 408.9 and 686.1 nm but at its optimum performance set between 488 and 514.5 nm.
  • a chemiluminescent label may be used. In such an instance, it may not be necessary to utilize an EM source for detection of the particle.
  • the extrinsic label or intrinsic characteristic of the particle is a light-interacting label or characteristic, such as a fluorescent label or a light-scattering label.
  • a source of EM radiation is used to illuminate the label and/or the particle. EM radiation sources for excitation of fluorescent labels are preferred.
  • the analyzer system consists of an electromagnetic radiation source 301. Any number of radiation sources may be used in any one analyzer system 300 Multiple sources of electromagnetic radiation have been previously disclosed in previous U.S. Pat. App. No. 11/048,660 . In some instances, all the continuous wave electromagnetic (EM) radiation sources emit electromagnetic radiation at the same wavelengths. In other instances, different sources emit different wavelengths of EM radiation.
  • EM continuous wave electromagnetic
  • the EM source(s) 301, 351, 352 are continuous wave lasers producing wavelengths of between 200 nm and 1000 nm.
  • Such EM sources have the advantage of being small, durable and relatively inexpensive. In addition, they generally have the capacity to generate larger fluorescent signals than other light sources.
  • suitable continuous wave EM sources include, but are not limited to: lasers of the argon, krypton, helium-neon, helium-cadmium types, as well as, tunable diode lasers (red to infrared regions), each with the possibility of frequency doubling.
  • the lasers provide continuous illumination with no accessory electronic or mechanical devices, such as shutters, to interrupt their illumination.
  • an electromagnetic radiation source of 3 mW may be of sufficient energy to excite a fluorescent label.
  • a beam from a continuous wave laser of such energy output may be between 2 to 5 ⁇ m in diameter.
  • the time of exposure of the particle to laser beam in order to be exposed to 3mW may be a time period of about 1 msec. In alternate instances, the time of exposure to the laser beam may be equal to or less than about 500 ⁇ sec. In an alternate instance, the time of exposure may be equal to or less than about 100 ⁇ sec. In an alternate instance, the time of exposure may be equal to or less than about 50 ⁇ sec. In an alternate instance, the time of exposure may be equal to or less than about 10 ⁇ sec.
  • LEDs are another low-cost, high reliability illumination source. Recent advances in ultra-bright LEDs and dyes with high absorption cross-section and quantum yield support the applicability of LEDs to single particle detection.
  • Such lasers could be used alone or in combination with other light sources such as mercury are lamps, elemental arc lamps, halogen lamps, arc discharges, plasma discharges, light-emitting diodes, or combination of these.
  • the EM source could be in the form of a pulse wave laser.
  • the pulse size of the laser is an important factor.
  • the size, focus spot, and the total energy emitted by the laser is important and must be of sufficient energy as to be able to excite the fluorescent label.
  • a pulse laser a pulse of longer duration may be required.
  • a laser pulse of 2 nanoseconds may be used.
  • a laser pulse of 5 nanoseconds may be used.
  • a pulse of between 2 to 5 nanoseconds may be used.
  • the optimal laser intensity depends on the photo bleaching characteristics of the single dyes and the length of time required to traverse the interrogation space (including the speed of the particle, the distance between interrogation spaces if more than one is used and the size of the interrogation space(s)). To obtain a maximal signal, it is desirable to illuminate the sample at the highest intensity which will not result in photo bleaching a high percentage of the dyes.
  • the preferred intensity is one such that no more that 5% of the dyes are bleached by the time the particle has traversed the interrogation space.
  • the power of the laser is set depending on the type of dye molecules that need to be stimulated and the length of time the dye molecules are stimulated, and/or the speed with which the dye molecules pass through the capillary flow cell.
  • Laser power is defined as the rate at which energy is delivered by the beam and is measured in units of Joules/second, or Watts. It will be appreciated that the greater the power output of the laser, the shorter the time that the laser illuminates the particle may be, while providing a constant amount of energy to the interrogation instances space while the particle is passing through the space.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is more than about 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, or 100 micro Joule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is less than about 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, or 110 microJoule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 0.1 and 100 microJoule. In some embodiments, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 1 and 100 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 1 and 50 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 2 and 50 micro Joule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 3 and 60 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 3 and 50 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 3 and 40 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is between about 3 and 30 microJoule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 1 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 3 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 5 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 10 microJoule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 15 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 20 microJoule. In some instances, the combination of the laser power and the time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 30 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 40 microJoule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 50 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 60 micro Joule. In some instances the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 70 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 80 microJoule.
  • the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 90 microJoule. In some instances, the combination of laser power and time of illumination is such that the total energy received by the interrogation space during the time of illumination is about 100 microJoule.
  • the laser power output is set to at least about 1 mW, 2 mW, 3mW, 4mW, 5 mW, 6, mw, 7 mW, 8 mW, 9 mW, 10 mW, 13 mW, 15 mW, 20 mW, 25 mW, 30 mW, 40 mW, 50 mW, 60 mW, 70 mW, 80 mW, 90 mW, 100 mW, or more than 100 mW.
  • the laser power output is set to at least about 1 mW.
  • the laser power output is set to at least about 3 mW.
  • the laser power output is set to at least about 5 mW.
  • the laser power output is set to at least about 10 mW. In some instances, the laser power output is set to at least about 20 mW. In some instances, the laser power output is set to at least about 30 mW. In some, the laser power output is set to at least about 40 mW. In some instances, the laser power output is set to at least about 50 mW. In some instances, the laser power output is set to at least about 60 mW. In some instances, the laser power output is set to at least about 90 mW.
  • the time that the laser illuminates the interrogation space can be set to no less than about 1, 2, 3, 4, 5, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 150, 200, 150, 300, 350, 400, 450, 500, 600, 700, 800, 900, or 1000 microseconds.
  • the time that the laser illuminates the interrogation space can be set to no more than about 2, 3, 4, 5, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 150, 200, 150, 300, 350, 400, 450, 500, 600, 700, 800, 900, 1000, 1500, or 2000 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 1 and 1000 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 5 and 500 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 5 and 100 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 10 and 100 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 10 and 50 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 10 and 20 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 5 and 50 microseconds.
  • the time that the laser illuminates the interrogation space can be set between about 1 and 100 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 1 microsecond.
  • the time that the laser illuminates the interrogation space is about 5 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 10 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 25 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 50 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 100 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 250 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 500 microseconds. In some instances, the time that the laser illuminates the interrogation space is about 1000 microseconds.
  • the time that the laser illuminates the interrogation space can be set to 1 millisecond, 250 microseconds, 100 microseconds, 50 microseconds, 25 microseconds or 10 microseconds with a laser that provides a power output of 3 mW, 4 mw, 5 mW, or more than 5 mW.
  • a label is illuminated with a laser that provides a power output of 3mW and illuminates the label for about 1000 microseconds.
  • a label is illuminated for less than 1000 milliseconds with a laser providing a power output of not more than about 20 mW.
  • the label is illuminated with a laser power output of 20 mW for less than or equal to about 250 microseconds.
  • the label is illuminated with a laser power output of about 5 mW for less than or equal to about 1000 microseconds.
  • the capillary flow cell is fluidly connected to the sample system.
  • the interrogation space 314 of an analyzer system is determined by the cross sectional area.of the corresponding beam 311 and by a segment of the beam within the field of view of the detector 309.
  • the interrogation space 314 has a volume, as defined herein, of between about between about 0.01 and 500 pL, or between about 0.01 pL and 100 pL, or between about 0.01 pL and 10 pL, or between about 0.01 pL and 1 pL, or between about 0.01 pL and 0.5 pL, or between about 0.02 pL and about 300 pL, or between about 0.02 pL and about 50 pL or between about 0.02 pL and about 5 pL or between about 0.02 pL and about 0.5 pL or between about 0.02 pL and about 2 pL, or between about 0.05 pL and about 50 pL, or between about 0.05 pL and about 5 pL, or between about 0.05 pL and about 0.5 pL, or between about 0.05 pL and about 0.2 pL or between about 0.1 pL and about 25 pL.
  • the interrogation space has a volume between about 0.01 pL and 10 pL. In some instances, the interrogation space 314 has a volume between about 0.01 pL and 1 pL. In some the interrogation space 314 has a volume between about 0.02 pL and about 5 pL. In some instances, the interrogation space 314 has a volume between about 0.02 pL and about 0.5 pL. In some instances, the interrogation space 314 has a volume between about 0.05 pL and about 0.2 pL. In some instances, the interrogation space 314 has a volume of about 0.1 pL. Other useful interrogation space volumes are as described herein.
  • the interrogation space 314 can be selected for maximum performance of the analyzer. Although very small interrogation spaces have been shown to minimize the background noise, large interrogation spaces have the advantage that low concentration samples can be analyzed in a reasonable amount of time. In instances in which two interrogation spaces 370 and 371 are used, volumes such as those described herein for a single interrogation space 314 may be used.
  • the interrogation spaces are large enough to allow for detection of particles at concentrations ranging from about 1000 femtomolar (fM) to about 1 zeptomolar (zM). In one instance, the interrogation spaces are large enough to allow for detection of particles at concentrations ranging from about 1000 fM to about 1 attomolar (aM). In one instance, the interrogation spaces are large enough to allow for detection of particles at concentrations ranging from about 10 fM to about 1 attomolar (aM). In many cases, the large interrogation spaces allow for the detection of particles at concentrations of less than about 1 fM without additional pre-concentration devices or techniques. One skilled in the art will recognize that the most appropriate interrogation space size depends on the brightness of the particles to be detected, the level of background signal, and the concentration of the sample to be analyzed.
  • the size of the interrogation space 314 can be limited by adjusting the optics of the analyzer.
  • the diameter of the beam 311 can be adjusted to vary the volume of the interrogation space 314.
  • the field of view of the detector 309 can be varied.
  • the source 301 and the detector 309 can be adjusted so that single particles will be illuminated and detected within the interrogation space 314.
  • the width of aperture 306 ( Figure 1A ) that determine the field of view of the detector 309 is variable. This configuration allows for altering the interrogation space, in near real time, to compensate for more or less concentrated samples, ensuring a low probability of two or more particles simultaneously being within an interrogation space. Similar alterations for two or more interrogation spaces, 370 and 371, may performed.
  • the interrogation space can be defined through the use of a calibration sample of known concentration that is passed through the capillary flow cell prior to the actual sample being tested.
  • the depth of focus together with the diameter of the beam of the electromagnetic radiation source determines the size of the interrogation space in the capillary flow cell.
  • the wall is one or more of the walls of a flow cell 313 ( Figure 2A ), when the sample fluid is contained within a capillary.
  • the cell is made of glass, but other substances transparent to light in the range of about 200 to about 1,000 nm or higher, such as quartz, fused silica, and organic materials such as Teflon, nylon, plastics, such as polyvinylchloride, polystyrene, and polyethylene, or any combination thereof, may be used although other cross-sectional shapes (e.g., rectangular, cylindrical) may be used in one instance, in one instance the capillary flow cell 313 has a square cross section.
  • the interrogation space may be defined at least in part by a channel (not shown) etched into a chip (not shown). Similar considerations apply to embodiments in which two interrogation spaces are used (370 and 371 in Fig. 2B ).
  • the interrogation space is bathed in a fluid.
  • the fluid is aqueous.
  • the fluid is non-aqueous or a combination of aqueous and non-aqueous fluids.
  • the fluid may contain agents to adjust pH, ionic composition, or sieving agents, such as soluble macroparticles or polymers or gels. It is contemplated that valves or other devices may be present between the interrogation spaces to temporarily disrupt the fluid connection. Interrogation spaces temporarily disrupted are considered to be connected by fluid.
  • an interrogation space is the single interrogation space present within the flow cell 313 which is constrained by the size of a laminar flow of the sample material within a diluent volume, also called sheath flow.
  • the interrogation space can be defined by sheath flow alone or in combination with the dimensions of the illumination source or the field of view of the detector.
  • Sheath flow can be configured in numerous ways, including:
  • the sample material is the interior material in a concentric laminar flow, with the diluent volume in the exterior; the diluent volume is on one side of the sample volume; the diluent volume is on two sides of the sample material; the diluent volume is on multiple sides of the sample material, but not enclosing the sample material completely; the diluent volume completely surrounds the sample material; the diluent volume completely surrounds the sample material concentrically; the sample material is the interior material in a discontinuous series of drops and the diluent volume completely surrounds each drop of sample material.
  • single molecule detectors comprise no more than one interrogation . space. In some instances, multiple interrogation spaces are used. Multiple interrogation spaces have been previously disclosed in U.S. Pat. App. No. 11/048,660 . One skilled in the art will recognize that in some cases the analyzer will contain 2, 3, 4, 5, 6 or more distinct interrogation spaces.
  • the particles are moved through the interrogation space by a motive force.
  • the motive force for moving particles is pressure.
  • the pressure is supplied by a pump, and air pressure source, a vacuum source, a centrifuge, or a combination thereof.
  • the motive force for moving particles is an electrokinetic force. The use of an electrokinetic force as a motive force has been previously disclosed in a prior application U.S. Pat. App. No. 11/048,660 .
  • pressure can be used as a motive force to move particles through the interrogation space of the capillary flow cell.
  • pressure is supplied to move the sample by means of a pump.
  • Suitable pumps are known in the art.
  • pumps manufactured for HPLC applications such as those made by Scivax, Inc. can be used as a motive force.
  • pumps manufactured for microfluidics applications can be used when smaller volumes of sample are being pumped.
  • Such pumps are described in U.S. Pat. Nos. 5,094,594 , 5,730,187 , 6,033,628 , and 6,533,553 , which discloses devices which can pump fluid volumes in the nanoliter or picoliter range.
  • PEEK polyetheretherketone
  • fused silica or sapphire.
  • a motive force is necessary to move the sample through the capillary flow cell to push the sample through the interrogation space for analysis.
  • a motive force is also required to push a flushing sample through the capillary flow cell after the sample has been passed through.
  • a motive force is also required to push the sample back out into a sample recovery vessel, when sample recovery is employed.
  • Standard pumps come in a variety of sizes, and the proper size may be chosen to suit the anticipated sample size and flow requirements. In some instances, separate pumps are used for sample analysis and for flushing of the system.
  • the analysis pump may have a capacity of approximately 0.000001 mL to approximately 10 mL, or approximately 0.001 mL to approximately 1 mL, or approximately 0.01 mL to approximately 0.2 mL, or approximately 0.005, 0.01, 0.05,0.1, or 0.5 mL.
  • Flush pumps may be of larger capacity than analysis pumps.
  • Flush pumps may have a volume of about 0.01 mL to about 20 mL, or about 0.1 mL to about 10 mL, or about 0.1 mL to about 2 mL, or about or about 0.05, 0.1, 0.5, 1, 5, or 10 mL.
  • pump sizes are illustrative only, and those of skill in the art will appreciate that the pump size may be chosen according to the application, sample size, viscosity of fluid to be pumped, tubing dimensions, rate of flow, temperature, and other factors well known in the art.
  • pumps of the system are driven by stepper motors, which are easy to control very accurately with a microprocessor.
  • the flush and analysis pumps are used in series, with special check valves to control the direction of flow.
  • the plumbing is designed so that when the analysis pump draws up the maximum sample, the sample does not reach the pump itself. This is accomplished by choosing the ID and length of the tubing between the analysis pump and the analysis capillary such that the tubing volume is greater than the stroke volume of the analysis pump.
  • light e.g., light in the ultra-violet, visible or infrared range
  • the detector 309 is capable of capturing the amplitude and duration of photon bursts from a fluorescent label-moiety complex, and further converting the amplitude and duration of the photon burst to electrical signals.
  • Detection devices such as CCD cameras, video input module cameras, and Streak cameras can be used to produce images with contiguous signals.
  • devices such as a bolometer, a photodiode, a photodiode array, avalanche photodiodes, and photomultipliers which produce sequential signals may be used. Any combination of the aforementioned detectors may also be used. In one instance, avalanche photodiodes are used for detecting photons.
  • the detector 309 is a photodiode that is used in reverse bias.
  • a photodiode set in reverse bias usually has an extremely high resistance. This resistance is reduced when light of an appropriate frequency shines on the PIN junction.
  • a reverse biased diode can be used as a detector by monitoring the current running through it. Circuits based on this effect are more sensitive to light than ones based on zero bias.
  • the photodiode can be an avalanche photodiode, which can be operated with much higher reverse bias than conventional photodiodes, thus allowing each photo-generated carrier to be multiplied by avalanche breakdown, resulting in internal gain within the photodiode, which increases the effective responsiveness (sensitivity) of the device.
  • the choice of photodiode is determined by the energy or emission wavelength emitted by the fluorescently labeled particle.
  • the photodiode is a silicon photodiode that detects energy in the range of 190-1100 nm; in another instance the photodiode is a germanium photodiode that detects energy in the range of 800-1700 nm; in another instance the photodiode is an indium gallium arsenide photodiode that detects energy in the range of 800-2600 nm; and in yet other instances, the photodiode is a lead sulfide photodiode that detects energy in the range of between less than 1000 nm to 3500 nm.
  • the avalanche photodiode is a single-photon detector designed to detect energy in the 400 nm to 1100 nm wavelength range.
  • Single photon detectors are commercially available (for example Perkin Elmer, Wellesley, MA).
  • the detector is a avalanche photodiode detector that detects energy between 300 nm and 1700 nm.
  • silicon avalanche photodiodes can be used to detect wavelengths between 300 nm and 1100 nm.
  • Indium gallium arsenic photodiodes can be used to detect wavelengths between 900nm and 1700 nm.
  • an analyzer system can comprise at least one detector; in other instances, the analyzer system can comprise at least two detectors, and each detector can be chosen and configured to detect light energy at a specific wavelength range.
  • an analyzer system can comprise a first detector that can detect fluorescent energy in the range of 450-700 nm such as that emitted by a green dye (e.g. Alexa 546); and a second detector that can detect fluorescent energy in the range of 620-780 nm such as that emitted by a far-red dye (e.g. Alexa 647).
  • Detectors for detecting fluorescent energy in the range of 400-600 nm such as that emitted by blue dyes (e.g. Hoechst 33342), and for detecting energy in the range of 560-700 nm such as that emitted by red dyes (Alexa 546 and Cy3) can also be used.
  • a system comprising two or more detectors can be used to detect individual particles that are each tagged with two or more labels that emit light in different spectra.
  • two different detectors can detect an antibody that has been tagged with two different dye labels.
  • an analyzer system comprising two detectors can be used to detect particles of different types, each type being tagged with a different dye molecules, or with a mixture of two or more dye molecules.
  • two different detectors can be used to detect two different types of antibodies that recognize two different proteins, each type being tagged with a different dye label or with a mixture of two or more dye label molecules.
  • two or more different particle types can be individually detected using two detectors. It is understood that three or more detectors can be used.
  • one or more detectors can be configured at each interrogation space, whether one or more interrogation spaces are defined within a flow cell, and that each detector may be configured to detect any of the characteristics of the emitted electromagnetic radiation listed above.
  • the use of multiple detectors, e.g., for multiple interrogation spaces, has been previously disclosed in a prior application U.S. Pat. App. No. 11/048,660 .
  • any suitable detection mechanism known in the art may be used, for example a CCD camera, a video input module camera, a Streak camera, a bolometer, a photodiode, a photodiode array, avalanche photodiodes, and photomultipliers producing sequential signals, and combinations thereof.
  • Different characteristics of the electromagnetic radiation may be detected including: emission wavelength, emission intensity, burst size, burst duration, fluorescence polarization, and any combination thereof.
  • the analyzer system may include a sampling system to prepare the sample for introduction into the analyzer system.
  • the sampling system included is capable of automatically sampling a plurality of samples and providing a fluid communication between a sample container and a first interrogation space.
  • the analyzer system includes a sampling system for introducing an aliquot of a sample into the single particle analyzer for analysis.
  • a sampling system for introducing an aliquot of a sample into the single particle analyzer for analysis. Any mechanism that can introduce a sample may be used. Samples can be drawn up using either a vacuum suction created by a pump or by pressure applied to the sample that would push liquid into the tube, or by any other mechanism that serves to introduce the sample into the sampling tube.
  • the sampling system introduces a sample of known sample volume into the single particle analyzer; in some instances where the presence or absence of a particle or particles is detected, precise knowledge of the sample size is not critical. In preferred instances the sampling system provides automated sampling for a single sample or a plurality of samples.
  • the sampling system provides a sample for analysis of more than about 0.0001, 0.001, 0.01, 0.1, 1, 2, 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 150, 200, 500, 1000, 1500, or 2000 ⁇ l. In some instances the sampling system provides a sample for analysis of less than about 2000, 1000, 500, 200, 100, 90, 80, 70, 60, 50, 40, 30,20, 10, 5,2, 1, 0.1, 0.01, or 0.001 ⁇ l.
  • the sampling system provides a sample for analysis of between about 0.01 and 1500 ⁇ l, or about 0.1 and 1000 ⁇ l, or about 1 and 500 ⁇ l, or about 1 and 100 ⁇ l, or about 1 and 50 ⁇ l, or about 1 and 20 ⁇ l. In some instances, the sampling system provides a sample for analysis between about 5 ⁇ l and 200 ⁇ l, or about 5 ⁇ l and about 100 ⁇ l, or about 5 ⁇ l and 50 ⁇ l. In some instances, the sampling system provides a sample for analysis between about 10 ⁇ l and 200 ⁇ l, or between about 10 ⁇ l and 100 ul, or between about 10 ⁇ l and 50 ⁇ l. In some embodiments, the sampling system provides a sample for analysis between about 0.5 ⁇ l and about 50 ⁇ l.
  • the sampling system provides a sample size that can be varied from sample to sample.
  • the sample size may be any one of the sample sizes described herein, and may be changed with every sample, or with sets of samples, as desired.
  • sample volume accuracy, and sample to sample volume precision of the sampling system is required for the analysis at hand.
  • the precision of the sampling volume is determined by the pumps used, typically represented by a CV of less than about 50, 40, 30, 20, 10, 5, 4, 3, 2, 1, 0.5, 0.1, 0.05, or 0.01% of sample volume.
  • the sample to sample precision of the sampling system is represented by a CV of less than about 50, 40, 30, 20,10, 5,4,3,2,1,0.5,0.1,0.05, or 0.01%.
  • the intra-assay precision of the sampling system is represented by a CV of less than about 10, 5, 1,0.5, or 0.1%.
  • the intra-assay precision of the sampling system shows a CV of less than about 5%.
  • the interassay precision of the sampling system is represented by a CV of less than about 10, 5, or 1%. In some instances, the interassay precision of the sampling system shows a CV of less than about 5%.
  • sample carryover is less than about 1,0.5, 0.1,0.05,0.04,0.03, 0.02,0.01, 0.005, or 0.001%. In some instances, sample carryover is less than about 0.02%. In some instances, sample carryover is less than about 0.01%.
  • the sampler provides a sample loop.
  • multiple samples are drawn into tubing sequentially and each is separated from the others by a "plug" of buffer.
  • the samples typically are read one after the other with no flushing in between. Flushing is done once at the end of the loop.
  • the plug may be recovered ejecting the buffer plug into a separate well of a microtiter plate.
  • the sampling system may be adapted for use with standard assay equipment, for example, a 96-well microtiter plate or, preferably, a 384-well plate.
  • the system includes a 96 well plate positioner and a mechanism to dip the sample tube into and out of the wells, e.g., a mechanism providing movement along the X, Y, and Z axes.
  • the sampling system provides multiple sampling tubes from which samples may be stored and extracted from, when testing is commenced. In some embodiments, all samples from the multiple tubes are analyzed on one detector. In other instances, multiple single molecule detectors may be connected to the sample tubes. Samples may be prepared by steps that include operations performed on sample in the wells of the plate prior to sampling by the sampling system, or sample may be prepared within the analyzer system, or some combination of both.
  • Sample preparation includes the steps necessary to prepare a raw sample for analysis. These steps can involve, by way of example, one or more steps of separation steps such as centrifugation, filtration, distillation, chromatography; concentration, cell lysis, alteration of pH, addition of buffer, addition of diluents, addition of reagents, heating or cooling, addition of label, binding of label, cross-linking with illumination, separation of unbound label, inactivation and/or removal of interfering compounds and any other steps necessary for the sample to be prepared for analysis by the single particle analyzer.
  • separation steps such as centrifugation, filtration, distillation, chromatography; concentration, cell lysis, alteration of pH, addition of buffer, addition of diluents, addition of reagents, heating or cooling, addition of label, binding of label, cross-linking with illumination, separation of unbound label, inactivation and/or removal of interfering compounds and any other steps necessary for the sample to be prepared for analysis by the single particle analyzer.
  • blood is treated to separate out
  • the analyzer system includes a sample preparation system that performs some or all of the processes needed to provide a sample ready for analysis by the single particle analyzer. This system may perform any or all of the steps listed above for sample preparation.
  • samples are partially processed by the sample preparation system of the analyzer system.
  • a sample may be partially processed outside the analyzer system first. For example, the sample may be centrifuged first. The sample may then be partially processed inside the analyzer by a sample preparation system. Processing inside the analyzer includes labeling the sample, mixing the sample with a buffer and other processing steps that will be known to one in the art.
  • a blood sample is processed outside the analyzer system to provide a serum or plasma sample, which is introduced into the analyzer system and further processed by a sample preparation system to label the particle or particles of interest and, optionally, to remove unbound label.
  • preparation of the sample can include immunodepletion of the sample to remove particles that are not of interest or to remove particles that can interfere with sample analysis.
  • the sample can be depleted of particles that can interfere with the analysis of the sample.
  • sample preparation can include the depletion of heterophilic antibodies, which are known to interfere with immunoassays that use non-human antibodies to directly or indirectly detect a particle of interest.
  • other proteins that interfere with measurements of the particles of interest can be removed from the sample using antibodies that recognize the interfering proteins.
  • the sample can be subjected to solid phase extraction prior to being assayed and analyzed.
  • a serum sample that is assayed for cAMP can first be subjected to solid phase extraction using a c 18 column to which it binds. Other proteins such as proteases, lipases and phosphatases are washed from the column, and the cAMP is eluted essentially free of proteins that can degrade or interfere with measurements of cAMP.
  • Solid phase extraction can be used to remove the basic matrix of a sample, which can diminish the sensitivity of the assay.
  • the particles of interest present in a sample may be concentrated by drying or lyophilizing a sample and solubilizing the particles in a smaller volume than that of the original sample.
  • a sample of exhaled breath condensate (EBC) can be dried and resuspended in a small volume of a suitable buffer solution to enhance the detection of the particle of interest.
  • EBC exhaled breath condensate
  • the analyzer system provides a sample preparation system that provides complete preparation of the sample to be analyzed on the system, such as complete preparation of a blood sample, a saliva sample, a urine sample, a cerebrospinal fluid sample, a lymph sample, a BAL sample, an exhaled breath condensate sample (EBC), a biopsy sample, a forensic sample, a bioterrorism sample, and the like.
  • the analyzer system provides a sample preparation system that provides some or all of the sample preparation.
  • the initial sample is a blood sample that is further processed by the analyzer system.
  • the sample is a serum or plasma sample that is further processed by the analyzer system.
  • the serum or plasma sample may be further processed by, e.g., contacting with a label that binds to a particle or particles of interest; the sample may then be used with or without removal of unbound label.
  • sample preparation is performed, either outside the analysis system or in the sample preparation component of the analysis system, on one or more microtiter plates, such as a 96-well plate. Reservoirs of reagents, buffers, and the like can be in intermittent fluid communication with the wells of the plate by means of tubing or other appropriate structures, as are well-known in the art. Samples may be prepared separately in 96 well plates or tubes. Sample isolation, label binding and, if necessary, label separation steps may be done on one plate. In some instances, prepared particles are then released from the plate and samples are moved into tubes for sampling into the sample analysis system. In some instances, all steps of the preparation of the sample are done on one plate and the analysis system acquires sample directly from the plate.
  • sample preparation system is capable of holding and preparing more than about 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 300, 500, 1000, 5000, or 10,000 samples.
  • multiple samples may be sampled for analysis in multiple analyzer systems.
  • 2 samples, or more than about 2, 3, 4, 5, 7, 10, 15 20, 50, or 100 samples are sampled from the sample preparation system and run in parallel on multiple sample analyzer systems.
  • Microfluidics systems may also be used for sample preparation and as sample preparation systems that are part of analyzer systems, especially for samples suspected of containing concentrations of particles high enough that detection requires smaller samples.
  • Principles and techniques of microfluidic manipulation are known in the art. See, e.g., U.S. Patent Nos.
  • the sample comprises a buffer.
  • the buffer may be mixed with the sample outside the analyzer system, or it may be provided by the sample preparation mechanism. While any suitable buffer can be used, the preferable buffer has low fluorescence background, is inert to the detectably labeled particle, can maintain the working pH and, in instances wherein the motive force is electrokinetic, has suitable ionic strength for electrophoresis.
  • the buffer concentration can be any suitable concentration, such as in the range from about 1 to about 200 mM. Any buffer system may be used as long as it provides for solubility, function, and delectability of the molecules of interest.
  • the buffer is selected from the group consisting of phosphate, glycine, acetate, citrate, acidulate, carbonate/bicarbonate, imidazole, triethanolamine, glycine amide, borate, MES, Bis-Tris, ADA, aces, PIPES, MOPSO, Bis-Tris Propane, BES, MOPS, TES, HEPES, DIPSO, MOBS, TAPSO, Trizma, HEPPSO, POPSO, TEA, EPPS, Tricine, Gly-Gly, Bicine, HEPBS, TAPS, AMPD, TABS, AMPSO, CHES, CAPSO, AMP, CAPS, and CABS.
  • the buffer can also be selected from the group consisting of Gly-Gly, bicine, tricine, 2-morpholine ethanesulfonic acid (MES), 4-morpholine propanesulfonic acid (MOPS) and 2-amino-2-methyl-1-propanol hydrochloride (AMP).
  • MES 2-morpholine ethanesulfonic acid
  • MOPS 4-morpholine propanesulfonic acid
  • AMP 2-amino-2-methyl-1-propanol hydrochloride
  • a useful buffer is 2 mM Tris/borate at pH 8.1, but Tris/glycine and Tris/HCl are also acceptable. Other buffers are as described herein.
  • Buffers useful for electrophoresis are disclosed in a prior application U.S. Pat. App. No. 11/048,660 .
  • One highly useful feature of instances of the analyzers and analysis systems is that the sample can be analyzed without consuming it. This can be especially important when sample materials are limited. Recovering the sample also allows one to do other analyses or reanalyze it.
  • the advantages of this feature for applications where sample size is limited and/or where the ability to reanalyze the sample is desirable, e.g., forensic, drug screening, and clinical diagnostic applications, will be apparent to those of skill in the art.
  • the analyzer system further provides a sample recovery system for sample recovery after analysis.
  • the system includes mechanisms and methods by which the sample is drawn into the analyzer, analyzed and then returned, e.g., by the same path, to the sample holder, e.g., the sample tube. Because no sample is destroyed and because it does not enter any of the valves or other tubing, it remains uncontaminated.
  • the sample path are highly inert, e.g., PEEK, fused silica, or sapphire, there is little contamination from the sample path.
  • the use of the stepper motor controlled pumps allows precise control of the volumes drawn up and pushed back out.
  • the recovered sample is undiluted. In some instances, the recovered sample is diluted less than about 1.5-fold, 1.4-fold, 1.3-fold, 1.2-fold, 1.1-fold, 1.05-fold, 1.01-fold, 1.005-fold, or 1.001-fold.
  • any mechanism for transporting a liquid sample from a sample vessel to the analyzer may be used.
  • the inlet end of the analysis capillary has attached a short length of tubing, e.g., PEEK tubing that can be dipped into a sample container, e.g. a test tube or sample well, or can be held above a waste container.
  • a sample container e.g. a test tube or sample well
  • this tube is positioned above the waste container to catch the flush waste.
  • drawing a sample in the tube is put into the sample well or test tube. Typically the sample is drawn in quickly, and then pushed out slowly while observing particles within the sample.
  • the sample is drawn in slowly during at least part of the draw-in cycle; the sample may be analyzed while being slowly drawn in. This can be followed by a quick return of the sample and a quick flush.
  • the sample may be analyzed both on the inward (draw-in) and outward (pull out) cycle, which improves counting statistics, e.g., of small and dilute samples, as well as confirming results, and the like. If it is desired to save the sample, it can be pushed back out into the same sample well it came from, or to another. If saving the sample is not desired, the tubing is positioned over the waste container.
  • the methods of the present invention make possible measurement of cardiac troponin levels at concentrations far lower than previously measured.
  • cardiac troponin is an accepted marker for cardiac muscle damage, its usefulness has been limited by the fact that, with current methods of analysis, it is only detectable after considerable damage to cardiac muscle has occurred, because of the lack of sensitivity of current methods.
  • the Joint European Society of Cardiology/American College of Cardiology committee for the Redefinition of Myocardial Infarction has recommended that an increased concentration of cardiac troponin be defined as a measurement exceeding the 99 th percentile of the distribution of cardiac troponin concentrations in the reference group, a very low threshold. A total imprecision (CV) at this decision limit of ⁇ 1 0% is recommended.
  • the analytical imprecision obtained with presently available immunoassays for cardiac troponins is not uniform, mainly at the low concentration range.
  • the assays that are currently available lack sufficient sensitivity for detecting troponin levels in nonclinical (normal) subjects, and a true baseline or a level of troponin defined in a normal population, has not been defined.
  • the analyzer systems disclosed herein have been shown to be able to consistently detect levels of cTnI at concentrations of less than 10 pg/ml with a total imprecision of less than 10% (See Examples).
  • the invention provides methods for diagnosing, predicting or prognosing based on the highly sensitive detection of cardiac troponin I in individuals.
  • the invention provides a method for diagnosing, predicting or prognosing acute myocardial infarction in an individual comprising: assaying a sample from the individual for cardiac troponin I (cTnI) and detecting a concentration of cTnI in the sample, wherein the sample is a plasma sample or a serum sample from blood; where the concentration is determined by a cardiac troponin I assay with a limit of detection for the cardiac troponin in said sample of less than about 5, 4,3,2 or 1 pg/ml, ; and comparing the detected concentration of cTnI to a threshold concentration of 7 pg/ml; wherein a cTnI level over the treshold concentration in a single sample indicates, predicts, or provides a basis for prognosis of AMI; wherein the individual is human.
  • cTnI cardiac troponin I
  • the method of determining the concentration of cardiac troponin includes any suitable method with the requisite sensitivity, e.g., the methods descried herein.
  • the methods utilize a method of determining a concentration of cardiac troponin in the sample where the method comprises detecting single molecules of troponin, or complexes or fragments thereof.
  • the threshold concentration of troponin is determined by analyzing samples, e.g., serum, or plasma samples, from an apparently healthy population for cardiac troponin, e.g., cardiac troponin I, and determining the level at which 80, 90,95,96,97,98,99, 99.5, or 99.9% of the population fall below that level (concentration). This value is the threshold value. In some embodiments, the threshold value is set at the 99 th percentile. In some embodiments, the analyzing is performed using a method with a level of detection for the cardiac troponin of less than about 5, or 1 pg/ml, e.g., less than about 5 pg/ml.
  • the invention provides a method for diagnosing predicting or prognosing by comparing a value for a concentration of cardiac troponin in a sample from the individual with a normal value for cardiac troponin, where the normal vale is determined by a cardiac troponin assay with a limit of detection for the cardiac troponin in said sample of less than about 50, 40, 30, 10, 5, 4,3,2 or 1 pg/ml, e.g., less than about 20 pg/ml; and ii) dagnosing, predicting or prognosing, based on comparison.
  • the cardiac troponin is cardiac troponin I.
  • the method may use total troponin, e.g., total cTnI, as described herein, in determining a diagnosis, prognosis In some embodiments, the method may use the concentration of free, complexed, or fragments of the cardiac troponin, or a comparison of these (e.g., a ratio), to determine a diagnosis, prognosis.
  • the sample or series of sample may be any suitable sample; in some embodiments, the sample(s) will be serum, or plasma. In some embodiments, the sample or series of samples are serum samples. The individual is human.
  • a single sample may be taken, or a series of samples may be taken. If a series of samples is taken, they may be taken at any suitable interval, e.g., intervals of minutes, hours, days, weeks, months, or years. In an acute clinical setting, typically a series of samples will be taken over the course of hours and days, with the samples separated by a matter of hours. When an individual is followed for longer periods, sample intervals may be months or years. Diagnosis, prognosis may be determined from a single sample, or from one or more of a series of samples, or from changes in the series of samples, e.g., an increase in concentration at a certain rate may indicate a severe condition whereas increase at a slower rate or no increase may indicate a relatively benign or less serious condition.
  • the rate of change may be measured over the course of hours, days, weeks, months, or years. Rate of change in a given individual may, in some cases, be more relevant than an absolute value.
  • an extremely rapid rate of change e.g., a "spike”
  • a rise in values over a period of days, weeks, months or years in an individual can indicate ongoing and worsening cardiac damage, e.g., cardiac damage due to a cardiac condition (e.g., cardiac hypertrophy or congestive heart failure) or cardiac damage due to a non-cardiac condition (e.g., toxicity from drug exposure).
  • At least one sample is taken during or after a cardiac stress test.
  • a sample may be taken before the stress test, and one or more samples taken during the test.
  • Deviations in cardiac troponin levels between the sample before the test and the sample(s) taken during the test can provide diagnostic or prognostic information, e.g., indicate the likelihood of coronary artery disease or other pathology associated with the cardiac muscle.
  • Other comparisons may be done as well, such as comparisons of any of the samples to normal or threshold levels, or determination of a rate of change in the concentration of cardiac troponin in the samples, all of which may yield useful information regarding cardiac and cardiovascular health, as well as other conditions as described herein.
  • At least one sample is taken at or near the time the individual presents to a health professional with one or more symptoms indicative of a condition that may involve cardiac damage.
  • Settings in which an individual may present to a health care professional include, but are not limited to ambulatory, urgent care, critical care, intensive care, monitoring unit, inpatient, outpatient, physician office, medical clinic, emergency response setting, including an ambulance, and health screening settings.
  • one or more samples are taken from the individual and are assayed for cardiac troponin locally, i.e., at or near the setting at which the samples are taken. For example, an individual who presents at a hospital may have one or more samples takent that are assayed for cardiac troponin within the hospital.
  • an individual who presents at a hospital may have one or more samples takent that are assayed for cardiac troponin within the hospital.
  • one or more samples are taken from the individual and are assayed for cardiac troponin in a CLIA laboratory.
  • the individual displays one or more symptoms consistent with acute coronary syndrome.
  • the individual displays one or more symptoms consistent with AMI.
  • symptoms include, but are not limited to, chest pain, chest pressure, arm pain, abnormal EKG, abnormal enzyme levels, and shortness of breath.
  • the method according to the invention includes comparing said concentration or series of concentrations to a predetermined threshold level
  • the method according to the invention comprises comparing said concentration of troponin in said sample with a predetermined threshold concentration, and determining a diagnosis, prognosis if the sample concentration is greater than the threshold level.
  • the threshold concentration can be determined by, e.g., determining the 99th percentile concentration of troponin in a group of individuals, and setting said threshold concentration at said 99th percentile concentration. An example of this is given in Examples.
  • Normal values, threshold values, rates of change, ratios of values, and other useful diagnostic and prognostic indicators may be established by methods well-known in the art. For example, these values may be determined by comparing samples from a case population and a control population, where the case population exhibits the biological state for which diagnosis, prognosis, or method of treatment is desired, and the control population does not exhibit the biological state.
  • a longitudinal study may be done, e.g., the case population may be a subset of the control population that, over time, exhibits the biological state. It will be appreciated that data from a plurality of studies may be used to determine a consensus value or range of values for normal, and for prognostic or diagnostic levels.
  • data for one or more potential markers may be obtained from a group of subjects.
  • the group of subjects is divided into at least two sets, and preferably the first set and the second set each have an approximately equal number of subjects.
  • the first set includes subjects who have been confirmed as having a disease or, more generally, being in a first condition state.
  • this first set of patients may be those that have recently had a disease incidence, or may be those having a specific type of disease, such as AMI.
  • the confirmation of the condition state may be made through a more rigorous and/or expensive testing such as MRI or CT.
  • subjects in this first set will be referred to as "diseased".
  • the second set of subjects is simply those who do not fall within the first set.
  • Subjects in this second set may be "non-diseased;” that is, normal subjects.
  • subjects in this second set may be selected to exhibit one symptom or a constellation of symptoms that mimic those symptoms exhibited by the "diseased" subjects.
  • this second set may represent those at a different time point from disease incidence.
  • data for the same set of markers is available for each patient.
  • This set of markers may include all candidate markers which may be suspected as being relevant to the detection of a particular disease or condition. Actual known relevance is not required.
  • Embodiments of the methods described herein may be used to determine which of the candidate markers are most relevant to the diagnosis of the disease or condition.
  • the levels of each marker in the two sets of subjects may be distributed across a broad range, e.g., as a Gaussian distribution. However, no distribution fit is required.
  • the methods of the invention are especially useful in diagnosis, prognosis, and/or treatment selection in patients suspected of acute myocardial infarct (AMI).
  • AMI acute myocardial infarct
  • the invention provides a method of diagnosing, predicting or prognosing AMI in an individual by assaying a sample from the individual, e.g., a plasma sample, and/or serum sample, for cTnI, and detecting a concentration of cardiac troponin in the sample at a limit of detection of less than about 5, 4, 3, 2, or 1 pg/ml, wherein the concentration of cardiac troponin in the sample indicates or predicts AMI.
  • the cardiac troponin is be cTnI, and may be total troponin or a measure of a particular form, e.g., free, complexed, or fragment; in some embodiments, a ratio of one or more forms of the troponin is used, as described herein.
  • total cTnI is measured in the sample or series of samples.
  • the cardiac troponin level is determined at or near the time the individual presents to a health professional with symptoms indicative of AMI. Such symptoms include, but are not limited to, chest pain, chest pressure, arm pain, abnormal EKG, abnormal enzyme levels, and shortness of breath.
  • a series of measurements is taken, and a spike in the cardiac troponin concentration in the samples indicates, predicts, or provides a basis for prognosis of AMI.
  • a spike of over 50%, over 100%, over 150%, over 200%, over 250%, over 300%, over 400%, or over 500% of baseline indicates, predicts, or provides a basis for prognosis of AMI.
  • a cardiac troponin level of over about 1, 2, 3,4, 5, 6, 7 pg/ml in a single sample indicates, predicts, or provides a basis for prognosis of AMI, regardless of baseline levels, if obtained.
  • diagnosis or prognosis includes stratification for the individual, based on cardiac troponin concentration in the sample or series of samples.
  • stratification may be based on the concentration of cardiac troponin in single samples, presence of spikes and/or size of spikes from baseline in a series of samples, ratios of different forms of the cardiac troponin, absolute values for different forms of cardiac troponin, rate of change in concentration for the cardiac troponin or for one or more forms of the cardiac troponin in a series of samples, change in ratios of different forms of cardiac troponin over time in a series of samples, and any other information based at least in part on cardiac troponin concentration in the sample or series of samples.
  • Stratification may be based on values obtained from populations of normal and diseased subjects, as described herein. Appropriate treatment may also be determined based on the stratification of the individual.
  • concentration of cardiac troponin is determined in combination with one or more other markers, e.g., markers of myocardial ischemia, myocardial infarct or markers of stroke, and the concentrations of each marker are considered in determining the diagnosis, prognosis, or method of treatment.
  • Other clinical indications typically will also be taken into account, e.g., EKG, symptoms, history, and the like, as will be apparent to those of skill in the art. Appropriate algorithms for diagnosis, prognosis, or treatment may be constructed based on the combinations of such markers and clinical indications in combination with troponin levels.
  • Markers useful in combination with cardiac troponin in the methods of the invention include but are not limited to creatine kinase (CK) and its myocardial fraction CK myocardial band (MB), aspartate aminotransferase, lactate dehydrogenase (LDH), ⁇ -hydroxybutyrate dehaydrogenase, myoglobin, glutamate oxaloacetate transaminase, glycogen phosphorylase BB, unbound free fatty acids, heart fatty acid binding protein (H-FABP), ischemia-modified albumin, myosin light chain 1, myosin light chain 2.
  • CK creatine kinase
  • MB myocardial fraction
  • LDH lactate dehydrogenase
  • ⁇ -hydroxybutyrate dehaydrogenase myoglobin
  • glutamate oxaloacetate transaminase glycogen phosphorylase BB
  • unbound free fatty acids H-FABP
  • Markers of inflammation and plaque instability useful in combination with cardiac troponin in the methods of the invention include but are not limited to C-reactive protein, white blood cell count, soluble CD40 ligand, myeloperoxidase, monocyte chemoattractant protein-1, whole blood choline, and pregnancy-associated plasma protein A.
  • Other markers of inflammation may be detected, and include combinations of I1-8, IL-1 ⁇ , IL6, IL10, TNF, and IL-12p70, as well as other cytokines or markers that will be apparent to those of skill in the art.
  • cardiac troponin, cTnI is measured together, e.g., in the same sample, or in samples from the same individual taken at or near the same time, with a marker selected from the group consisting of creatine kinase (CK) and its myocardial fraction CK myocardial band (MB), aspartate aminotransferase, lactate dehydrogenase (LDH), ⁇ -hydroxybutyrate dehaydrogenase, myoglobin, glutamate oxaloacetate transaminase, glycogen phosphorylase BB, unbound free fatty acids, heart fatty acid binding protein (H-FABP), ischemia-modified albumin, myosin light chain 1, and myosin light chain 2.
  • CK-MB creatine kinase
  • MB myocardial fraction
  • aspartate aminotransferase lactate dehydrogenase
  • LDH lactate dehydrogenase
  • cardiac troponin alone or in combination with other markers or clinical signs, measured as described herein, is used to determine reinfarction.
  • cardiac troponin, alone or in combination with other markers or clinical signs, measured as described herein is used to determine characteristics of an infarct, e.g., size, or duration since infarct.
  • infarct characteristics of an infarct
  • fragments of troponin produced by proteolyis in the blood may be compared to total troponin; the greater the proportion of fragments, the more time has elapsed since infarct.
  • cardiac troponin Many conditions include potential or actual cardiac damage, and the ability to measure cardiac troponin at the levels described herein allow for early detection of such damage and early intervention. Knowledge of the concentration of cardiac troponin as measured by the methods of the invention is useful in diagnosis, prognosis, and determination of treatment for such conditions.
  • Conditions include percutaneous coronary interventions, cardiac surgery, heart failure, acute rheumatic fever, amyloidosis, cardiac trauma (including contusion, ablation, pacing, firing, cardioversion, catheterization and cardiac surgery), reperfusion injury, cardiotoxycity from cancer therapy, congestive heart failure, end-stage renal failure, glycogen storage disease type II (Pompe's disease), heart transplantation, haeomoglobinopathy with transfusion haemosiderosis, hypertension, including gestational hypertension, hypotension, often with arrhythmias, hypothyroidism, myocarditis, pericarditis, post-operative non-cardiac surgery, pulmonary embolism, and sepsis.
  • the troponin levels may be determined concomitantly with the levels of marker(s) that are specific for the non-cardiac disease, or other symptoms or clinical signs of the disease; the markers) concentration and/or information regarding other symptoms or clinical signs is combined with information regarding cardiac troponin concentrations, determined as described herein, to determine a diagnosis, prognosis, and/or method of treatment.
  • the disclosed methods may employ, in addition to determination of cardiac troponin concentration, determination of the concentration of one or more of the polypeptides referenced above, or other protein markers useful in diagnosis, prognosis, or differentiation of disease.
  • a panel of markers for the disease may be provided, where the panel includes cardiac troponin concentration, as described herein, and at least on other marker for the disease.
  • the panel may include, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, or more or individual markers, which including one or more cardiac troponins, e.g., total cTnI.
  • cardiac troponins e.g., total cTnI.
  • the analysis of a single marker or subsets of marker can be carried out by one skilled in the art to optimize clinical sensitivity or specificity in various clinical settings. These include, but are not limited to ambulatory, urgent care, critical care, intensive care, monitoring unit, inpatient, outpatient, physician office, medical clinic, and health screening settings. Furthermore, one skilled in the art can use a single marker or a subset of markers in combination with an adjustment of the diagnostic threshold in each of the aforementioned settings to optimize clinical sensitivity and specificity.
  • the methods of the invention are especially useful in determining and monitoring cardiac toxicity that results from a treatment, e.g., cardiac toxicity of drug treatment.
  • An illustrative example, which is not an aspect of the invention is a method of assessing cardiac toxicity of a treatment by measuring cardiac troponin in an individual by i) determining a concentration of cardiac troponin in a sample or determining the concentrations of cardiac troponin in a series of samples from the individual, where at least one of the samples is taken from the individual during or after a time when the individual is receiving the treatment, where the concentration or concentrations is determined by a cardiac troponin assay with a limit of detection for the cardiac troponin in said sample of less than about 50, 40, 30, 10, 5, 4,3,2 or 1 pg/ml, e.g., less than about 20 pg/ml; and ii) assessing the degree of cardiac toxicity of the treatment based on said concentration or concentrations.
  • the treatment is a drug treatment. In some instances, the treatment is a non-drug treatment.
  • the method of determining the concentration of cardiac troponin includes any suitable method with the requisite sensitivity, e.g., the methods described herein. In some instances, the methods utilize a method of determining a concentration of cardiac troponin in the sample where the method comprises detecting single molecules of troponin, or complexes or fragments thereof.
  • Such antibodies may be used in animal studies of drug toxicity, where the individual for which toxicity is assessed is, e.g., a mammal, such as a rat, mouse, dog, monkey, or other animal used in such studies. Toxicity in various species may be directly compared when the antibody used in the assay is the same antibody, thus reducing variability.
  • the methods of the invention may be used in conjunction with specific drugs whose side effects include cardiotoxicity in order to monitor the cardiac toxicity.
  • the invention provides methods of monitoring cardiac toxicity in an individual who is receiving a drug that is known to cause cardiac toxicity by determining the concentration of cardiac troponin in one or more samples obtained from the individual, where the concentration or concentrations is determined by a cardiac troponin assay with a limit of detection for the cardiac troponin in said sample or samples of less than about 50, 40, 30, 10, 5, 4,3,2 or 1 pg/ml, e.g., less than about 20 pg/ml; and ii) assessing the degree of cardiac toxicity of the drug treatment based on said concentration or concentrations.
  • the method further includes a step iii) determining whether or not to continue the drug treatment based on the assessment of step ii). Drugs whose side effects include cardiac toxicity are well-known in the art.
  • the invention are systems and methods (including business methods) for establishing markers of cardiac troponin that can be used for diagnosing, prognosing, or determining a method of treatment of a biological state or a condition in an organism, preparing diagnostics based on such markers, and commercializing/marketing diagnostics and services utilizing such diagnostics.
  • the biological state may be acute myocardial infarct, or cardiac damage due to drug toxictiy, or non-AMI states as described herein.
  • the business methods herein comprise: establishing one or more cardiac troponin markers using a method comprising: establishing a range of concentrations for said marker or markers in biological samples obtained from a first population by measuring the concentrations of the marker or markers in the biological samples by detecting single molecules of the marker or markers at a level of detection of less than about 50, 20, 10, 5, or 1 pg/ml; and commercializing the one or more markers established in the above step, e.g., in a diagnostic product.
  • the diagnostic product herein can include one or more antibodies that specifically binds to the cardiac troponin marker and a fluorescent moietythat is capable of emitting an average of at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the business methods herein comprise: establishing a range of normal values for a cardiac troponin marker using a system comprising: establishing a range of concentrations for said cardiac troponin marker in biological samples obtained from a first population by measuring the concentrations of the marker the biological samples by detecting single molecules of the marker at a level of detection less thatn about 50, 20, 10, 5, or 1 pg/ml; and providing a diagnostic service to determine if an organism has or does not have a state or condition of interest, e.g., AMI, cardiac toxicity due to drug treatment, or a non-AMI condition.
  • a diagnostic service herein may be provided by a CLIA approved laboratory that is licensed under the business or the business itself.
  • the diagnostic services herein can be provided directly to a health care provider, a health care insurer, or a patient.
  • the business methods herein can make revenue from selling e.g., diagnostic services or diagnostic products.
  • the business methods herein also contemplate providing diagnostic services to, for example, health care providers, insurers, patients, etc.
  • the business herein can provide diagnostic services by either contracting out with a service lab or setting up a service lab (under Clinical Laboratory Improvement Amendment (CLIA) or other regulatory approval).
  • Such service lab can then carry out the methods disclosed herein to identify if a cardiac troponin marker is within a sample.
  • CLIA Clinical Laboratory Improvement Amendment
  • compositions useful in the detection and quantitation of cardiac troponin include binding partners to cardiac troponin that are labeled with suitable labels for detection by the methods of the invention, pairs of binding partners in which one or both of the binding partners are labeled with suitable labels for detection by the methods of the invention, solid supports to which capture binding partners are attached, in some instances also with detection binding partners.
  • Examples include a composition for the detection of cardiac troponin that includes a binding partner to the cardiac troponin attached to a fluorescent moiety, where the fluorescent moiety is capable of emitting an average of at least about 200 photons when simulated by a laser emitting light at the excitation wavelength of the moiety, where the laser is focused on a spot of not less than about 5 microns in diameter that contains the moiety, and wherein the total energy directed at the spot by the laser is no more than about 3 microJoules.
  • the binding partner includes an antibody to the cardiac troponin.
  • the antibody is a polyclonal antibody.
  • the antibody is a monoclonal antibody.
  • the antibody is a cross-reacting antibody, e.g., an antibody that cross-reacts with cardiac troponin from at least two species, e.g., at least two species selected from the group consisting of human, monkey, dog, and mouse. In some instances the antibody cross-reacts with cardiac troponins from all of human, monkey, dog, and mouse. In some instances, the cardiac troponin is selected from the group consisting of cTnI and cTnT. In some instances, the cardiac troponin is cTnI. In some embodiments, cardiac troponin is cTnT.
  • the antibody may specific to a specific region of the troponin molecule, e.g., specific to a region comprising amino acids 27-41 of cardiac troponin I.
  • the fluorescent moiety may contain one or more molecules that comprises at least one substituted indolium ring system in which the substituent on the 3-carbon of the indolium ring contains a chemically reactive group or a conjugated substance, group.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules selected from the group consisting of AlexaFluor 488, 532, 647, 700, or 750.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules selected from the group consisting of AlexaFluor 488, 532, 700, or 750.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 488.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 555.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 610.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 647.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 680.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 700.
  • the label composition may include a fluorescent moiety that includes one or more dye molecules that are AlexaFluor 750.
  • compositions that includes a set of standards for the determination of a concentration of a cardiac troponin, wherein at least one of the standards is at a concentration of cardiac troponin less than about 20, 15, 10, 5, 4, 3, 2, or 1 pg/ml. Further disclosed is a composition that includes a set of standards for the determination of a concentration of a cardiac troponin, wherein at least one of the standards is at a concentration of cardiac troponin less than about 20 pg/ml. Further disclosed is a composition that includes a set of standards for the determination of a concentration of a cardiac troponin, wherein at least one of the standards is at a concentration of cardiac troponin less than about 10 pg/ml.
  • composition that includes a set of standards for the determination of a concentration of a cardiac troponin, wherein at least one of the standards is at a concentration of cardiac troponin less than about 5 pg/ml. Further disclosed is a composition that includes a set of standards for the determination of a concentration of a cardiac troponin, wherein at least one of the standards is at a concentration of cardiac troponin less than about 1 pg/ml.
  • compositions of the invention are as described herein.
  • kits include one or more compositions useful for the sensitive detection of cardiac troponin, as described herein, in suitable packaging.
  • Exemplary kits provide labels, e.g., binding partner such as an antibody that is specific for cardiac troponin, where the binding partner is attached to a fluorescent moiety.
  • Exemplary kits provide binding partner pairs, e.g., antibody pairs, that are specific for cardiac troponin, where at least one of the binding partners is a label for a cardiac troponin, as described herein.
  • the binding partners e.g., antibodies
  • the binding partners are provided in separate containers.
  • the binding partners, e.g., antibodies are provided in the same container.
  • one of the binding partners e.g., antibody
  • a solid support e.g., a microtiter plate or a paramagnetic bead.
  • the other binding partner e.g., antibody
  • Binding partners e.g., antibodies, solid supports, and fluorescent labels for components of the kits may be any suitable such components as described herein.
  • kits may additionally include reagents useful in the methods of the invention, e.g., buffers and other reagents used in binding reactions, washes, buffers or other reagents for preconditioning the instrument on which assays will be run, and elution buffers or other reagents for running samples through the instrument.
  • reagents useful in the methods of the invention e.g., buffers and other reagents used in binding reactions, washes, buffers or other reagents for preconditioning the instrument on which assays will be run, and elution buffers or other reagents for running samples through the instrument.
  • Kits may include one or more standards, e.g., standards for use in the assays disclosed herein such as standards of highly purified, e.g., recombinant, human cTnI or human cTnT, or various fragments, complexes, and the like, thereof. Kits may further include instructions.
  • standards e.g., standards for use in the assays disclosed herein such as standards of highly purified, e.g., recombinant, human cTnI or human cTnT, or various fragments, complexes, and the like, thereof. Kits may further include instructions.
  • the assay The purpose of this assay was to detect the presence of cardiac Troponin I (cTNI) in human serum.
  • the assay format was a two-step sandwich immunoassay based on a mouse monoclonal capture antibody and a goat polyconal detection antibody. Ten microliters of sample were required.
  • the working range of the assay is 0 - 900 pg/ml with a typical analytical limit of detection of 1 - 3 pg/ml.
  • the assay required about four hours of bench time to complete.
  • the detection antibody G-129-C was conjugated to AlexaFluor 647 by first dissolving 100ug of G-129-C in 400uL of the coupling buffer (0.1M NaHCO3). The antibody solution was then concentrated to 50ul by transferring the solution into YM-30 filter and subjecting the solution and filter to centrifugation. The YM-30 filter and antibody was then washed three times by adding 400ul of the coupling buffer. The antibody was recovered by adding 50 ⁇ 1 to the filter, inverting the filter, and centrifuging for 1 minute at 5,000 x g. The resulting antibody solution was 1-2ug/ul.
  • the coupling buffer 0.1M NaHCO3
  • AlexaFluor 647 NHS ester was reconstituted by adding 20ul DMSO to one vial of AlexaFluor 647, this solution was stored at -20oC for up to one month. 3ul of AlexaFluor 647 stock solution was added to the antibody solution, which was then mixed and incubated in the dark for one hour. After the one hour, 7.5ul 1M tris was added to the antibody AlexaFluor 647 solution and mixed. The solution was ultrafiltered with YM-30 to remove low molecular weight components. The volume of the retentate, which contained the antibody conjugated to AlexaFluor 647, was adjusted to 200-400 ⁇ I by adding PBS. 3ul 10% NaN3 was added to the solution, the resulting solution was transferred to an Ultrafree 0.22 centrifugal unit and spun for 2 minutes at 12,000 x g. The filtrate containing the conjugated antibody was collected and used in the assays.
  • the standard curve was prepared as follows: working standards were prepared (0 - 900 pg/ml) by serial dilutions of the stock of cTnI into standard diluent or to achieve a range of cTnI concentrations of between 1.2 pg/ml - 4.3 ⁇ g/ml.
  • LoD analytical limit of detection
  • the assays described above use the same microtiter plate format where the plastic surface is used to immobilize target molecules.
  • the single particle analyzer system also is compatible with assays done in solution using microparticles or beads to achieve separation of bound from unbound entities.
  • MyOne Streptavidin C1 microparticles are obtained from Dynal (650.01-03, 10 mg/ml stock).
  • Buffers use in the assay include: 10X borate buffer saline Triton Buffer (BBST) (1.0 M borate, 15.0 M sodium chloride, 10% Triton X-100, pH 8.3); assay buffer (2 mg/ml normal goat IgG, 2 mg/ml normal mouse IgG, and 0.2 mg/ml MAB-33-IgG-Polymer in 0.1 M Tris (pH 8.1), 0.025 M EDTA, 0.15 M NaCl, 0.1% BSA, 0.1% Triton X-100, and 0.1% NaN3, stored at 4C); and elution buffer (BBS with 4 M urea, 0.02% Triton X-100, and 0.001% BSA, stored at 2-8C).
  • BBST 10X borate buffer saline Triton Buffer
  • assay buffer 2 mg/ml normal goat I
  • Antibodies used in the sandwich bead-based assay include: Bio-Ab (A34650228P (Bios Pacific) with 1-2 biotins per IgG) and Det-Ab (G-129-C (Bios Pacific) conjugated to A647, 2-4 fluors per IgG).
  • the standard is recombinant human cardiac troponin I (Bios Pacific, cat # J34120352).
  • the calibrator diluent is 30 mg/ml BSA in TBS wEDTA.
  • Microparticles Coating 100 ul of the MPs stock is placed in an eppendorf tube. The MPs are washed three times with 100 ul of BBST wash buffer by applying a magnet, removing the supernatant, removing the magnet, and resuspending in wash buffer. After the washes the MPs are resuspended in 100 ul of assay buffer and 15 ug of Bio-Ab are added. The mixture is then incubated for an hour at room temperature with constant mixing. The MPs are washed five times with 1 ml wash buffer as described above. After the washes the MPs are resuspended in 15 ml of assay buffer (or 100 ul to store at 4 0C).
  • Standard and Samples The standard is diluted with calibrator diluent to prepare proper standard curve (usually 200 pg/ml down to 0.1 pg/ml). Frozen serum and plasma samples need to be centrifuged 10 minutes at room temperature at 13K rpm. Clarified serum/plasma is removed carefully to avoid taking any possible pellets or floaters and put into fresh tubes. 50 ul of each standard or sample is pippetted into appropriate wells.
  • Capture Target 150 ul of MPs (after resuspension to 15 ml in assay buffer + 400 mM NaCl) are added to each well. The mixture is incubated on JitterBug, 5 at room temperature for 1 hr.
  • washes and Detection The plate is placed on a magnet and the supernatant is removed after ensuring that all MPs are captured by the magnet. 250 ul of wash buffer are added after removing the plate from the magnet. The plate is then placed on the magnet and the supernatant is removed after ensuring that all MPs are captured by the magnet. 20 ul Det-Ab are added per well (Det-Ab to 500 ng/ml is diluted in assay buffer + 400 mM NaCl)). The mixture is incubated on JitterBug, 5 at room temperature for 30 min.
  • washes and Elution The plate is placed on a magnet and washed three times with wash buffer. The supernatant is removed after ensuring that all MPs are captured by the magnet and 250 ul of wash buffer are added. After the washes the samples are transferred into a new 96-well plate. The new plate is then placed on the magnet and the supernatant is removed after ensuring that all MPs are captured by the magnet. 250 ul of wash buffer are then added after removing the plate from the magnet. The plate is then placed on the magnet and the supernatant is removed after ensuring that all MPs are captured by the magnet. 20 ul of elution buffer are then added and the mixture is incubated on JitterBug, 5 at room temperature for 30 min.
  • Filter out MPs and transfer to 384-well plate The standard and samples are transferred into a 384-well filter plate placed on top of a 384-well assay plate. The plate is then centrifuged at room temperature at 3000 rpm with a plate rotor. The filter plate is removed and the appropriate calibrators are added. The plate is covered and is ready to be run on SMD.
  • SMD An aliquot is pumped into the analyzer. Individually-labeled antibodies are measured during capillary flow by setting the interrogation volume such that the emission of only 1 fluorescent molecule is detected in a defined space following laser excitation. With each signal representing a digital event, this configuration enables extremely high analytical sensitivities. Total fluorescent signal is determined as a sum of the individual digital events. Each molecule counted is a positive data point with hundreds to thousands of DMC events/sample. The limit of detection the cTnI assay of the invention is determined by the mean +3 SD method.
  • Example 3 Concentration range for cTnI in a population of normal non-diseased subjects.
  • a reference range or normal range for cTnI concentrations in human serum was established using serum samples from 88 apparently healthy subjects (non-diseased).
  • a sandwich immunoassay as described in Example 1 was performed and the number of signals or events as described above were counted using the single particle analyzer system of the invention.
  • the concentration of serum troponin I was determined by correlating the signals detected by the analyzer with the standard curve as described above. All assays were perfumed in quadruplicate.
  • troponin assays should quantify accurately the 99th percentile of the normal range with an assay imprecision (CV) of less than 10% in order to distinguish reliably between patients with ACS and patients without ischemic heart disease, and risk stratification for adverse cardiac events.
  • CV assay imprecision
  • the assay showed that the biological threshold (cutoff concentration) for TnI is at a TnI concentration of 7pg/ml, which is established at the 99th percentile with a corresponding CV of 10% ( Figure 5 ).
  • the precision profile points at a TnI concentration of 4 and 12 pg/ml.
  • the assay correlates well with the Troponin-I standard measurements provided by the National Institute of Standards and Technology ( Figure 6 ).
  • the assay of the invention is sufficiently sensitive and precise to fulfill the requirements of the ESC/ACC, and it is the most sensitive assay for cardiac troponin I when compared to assays such as those described by Koerbin et al.(Ann Clin Biochem, 42:19-23 (2005 ).
  • the assay of the invention has a 10-20 fold greater sensitivity than that currently available assays, which has determined the biological threshold range to be 111-333 pg/ml cTnI.
  • Study 1 47 samples were obtained serially from 18 patients that presented with chest pain in the emergency department (ED). These patients all had non-ST elevated ECG were, and were diagnosed with AMI. The concentration of cTni in the initial samples from all 18 patients was determined according to a commercial assay at the time of admission to the emergency room to be ⁇ 350 pg/ml (10% cutpoint), and 12 were ⁇ 100 pg/ml (99th%) percentile. These samples were tested at later times using the same commercial assay, and were determined to test positive for cTnI. The same serum samples were also assayed for TnI according to the assay of the invention as described in Examples 1 and 3, and the results compared to the results obtained using the commercial assay.
  • Blood was drawn for the first time at the time the patient presented with chest pain (sample 1), and subsequently at intervals between 4-8 hours (samples 2 at 12 hours; sample 3 at 16 hours; sample 4 at 24 hours; sample 5 at 30 hours; sample 6 at 36 hours; sample 7 at 42 hours; and sample 8 at 48 hours).
  • the serum was analyzed by the methods of the invention and by a current commercial method, and the results obtained are shown in Figure 7 .
  • the analyzer of the invention detected TnI at the time the patient presented with chest pain (sample 1), while the commercial assay first detected cTnI at a much later time (sample 6 at 36 hours).
  • the concentration of TnI in sample 3 exceeded the biological threshold level that was established using the analyzer of the invention (7 pg/ml, see Figure 5 ), and indicated that sample 3 is positive for TnI to suggest the incidence of a cardiac event.
  • the biological threshold for the commercial assay lies between 111 and 333 pg/ml of TnI. Accordingly, sample 3 would not have been considered to indicate a possible cardiac event.
  • the methods and compositions of the present invention allow for much earlier diagnosis and possible intervention based on cardiac troponin levels, as evidenced by results for the first sample taken from the patients.
  • cTnI values of between 100 and 350 ng/ml
  • all were positive for cTnI by the analytical methods of the invention i.e., cTnI over 7 pg/ml.
  • 5 were determined to be positive for a cardiovascular event according to the assay of the invention i.e., cTnI over 7 pg/ml.
  • the prospective use of the assay of the invention would have detected 53% more AMI cases than the current commercial assay when the admission sample was tested.
  • Study 2 50 additional serum samples, which tested negative according to the commercial assay, were tested using the analyzer and assay of the invention. The results are shown in Figure 8 . Of the 50 samples, 36 were within the 99th% and determined to be within the normal range established by the assay of the invention. However, the remaining 14 samples that were determined to be within the commercial "normal" or non-diseased range, tested above the biological threshold established by the invention.
  • the high sensitivity cTnI assay of the invention allows for the detection of myocardial damage in patients when cTnI serum levels are below threshold values by commercially available technology.
  • the use of the highly sensitive and precise cTnI assay of the invention enables detection of AMI earlier than with existing cTnI assays, and thereby provides the opportunity for appropriate diagnosis and early medical intervention to improve the outcome.

Claims (4)

  1. Procédé de diagnostic, de prédiction ou de pronostic d'un infarctus aigu du myocarde (IAM) chez un individu, comprenant :
    le dosage d'un échantillon provenant de l'individu pour la troponine cardiaque I (cTnI) et la détection d'une concentration de cTnl dans l'échantillon, dans lequel l'échantillon est un échantillon de plasma ou un échantillon de sérum sanguin ; dans lequel ladite concentration est déterminée par un dosage de cTnl avec une limite de détection pour ladite cTnl dans ledit échantillon de moins de 5 pg/ml ; et
    la comparaison de la concentration détectée de cTnI à une concentration seuil de 7 pg/ml ;
    dans lequel un taux de cTnl supérieur à la concentration seuil dans un seul échantillon indique, prédit ou fournit une base pour le pronostic d'un IAM ;
    dans lequel l'individu est un être humain.
  2. Procédé selon la revendication 1, dans lequel l'échantillon est un échantillon de sérum.
  3. Procédé selon la revendication 1 ou la revendication 2, dans lequel le taux de cTnl est déterminé au moment ou proche du moment où l'individu se présente chez un professionnel de santé avec un ou plusieurs symptômes indicatifs d'un IAM.
  4. Procédé selon la revendication 3, dans lequel le ou les symptômes sont une douleur thoracique, une pression thoracique, une douleur au bras, un ECG anormal, des taux d'enzymes anormaux, ou un essoufflement.
EP18205921.2A 2006-04-04 2007-04-04 Procédé d'évaluation de l'infarctus du myocarde aigu fondé sur une analyse hautement sensible de la troponine cardiaque Active EP3495822B1 (fr)

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US78930406P 2006-04-04 2006-04-04
US79366406P 2006-04-19 2006-04-19
US80862206P 2006-05-26 2006-05-26
US86149806P 2006-11-28 2006-11-28
US87298606P 2006-12-04 2006-12-04
EP16193284.3A EP3168618B1 (fr) 2006-04-04 2007-04-04 Procédés d'analyse de troponine hautement sensible
EP07754941.8A EP2002260B1 (fr) 2006-04-04 2007-04-04 Système et procédés hautement sensibles destinés à une analyse de la troponine
EP11188077A EP2472258A3 (fr) 2006-04-04 2007-04-04 Système hautement sensible et procédés d'analyse de troponine
PCT/US2007/008506 WO2007114947A2 (fr) 2006-04-04 2007-04-04 Système et procédés hautement sensibles destinés à une analyse de la troponine

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EP11188077A Withdrawn EP2472258A3 (fr) 2006-04-04 2007-04-04 Système hautement sensible et procédés d'analyse de troponine
EP11169710.8A Revoked EP2386858B1 (fr) 2006-04-04 2007-04-04 Système hautement sensible et procédés d'analyse de troponine
EP18205921.2A Active EP3495822B1 (fr) 2006-04-04 2007-04-04 Procédé d'évaluation de l'infarctus du myocarde aigu fondé sur une analyse hautement sensible de la troponine cardiaque
EP07861282.7A Withdrawn EP2016394A4 (fr) 2006-04-04 2007-04-04 Procédés et compositions d'analyse extrêmement sensible de marqueurs et de détection de molécules
EP16193284.3A Active EP3168618B1 (fr) 2006-04-04 2007-04-04 Procédés d'analyse de troponine hautement sensible
EP07754941.8A Revoked EP2002260B1 (fr) 2006-04-04 2007-04-04 Système et procédés hautement sensibles destinés à une analyse de la troponine
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EP16193284.3A Active EP3168618B1 (fr) 2006-04-04 2007-04-04 Procédés d'analyse de troponine hautement sensible
EP07754941.8A Revoked EP2002260B1 (fr) 2006-04-04 2007-04-04 Système et procédés hautement sensibles destinés à une analyse de la troponine
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CA2648382A1 (fr) 2008-04-24
US9977031B2 (en) 2018-05-22
EP2472258A2 (fr) 2012-07-04
EP2016394A2 (fr) 2009-01-21
ES2703813T3 (es) 2019-03-12
WO2008048371A2 (fr) 2008-04-24
EP4357783A2 (fr) 2024-04-24
ES2550004T3 (es) 2015-11-03
AU2007233320B2 (en) 2013-12-12
EP2002260A4 (fr) 2009-08-05
EP2386858B1 (fr) 2015-07-15
ES2560864T3 (es) 2016-02-23
JP5308328B2 (ja) 2013-10-09
JP2013224954A (ja) 2013-10-31
WO2008048371A9 (fr) 2008-11-27
EP2472258A3 (fr) 2012-11-28
AU2007233320A1 (en) 2007-10-11

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